How is life as a doctor in Singapore?

Originally Posted by Unregistered

I think you are too generous with your assessment of FM Mmed, it is rubbish for becoming a GP. Not even recognised in Malaysia. Want to be GP just finish your bond and gain more experience in the real world. GDFM optional.

Once again proving that this group is filled with juvenile doctors with childish comments.
“Not even recognized in Malaysia” = “rubbish for becoming a GP”
Okay can.

Having worked in multiple FM settings from public to private, I can assure you that MMed is not rubbish.
It’s only rubbish for those who love simple MBBS style medicine. Manage everything textbook style and refer everything else along. Fudge your way through if you’re not sure.

I’m not saying being a private GP is easy. There are a lot of other challenges that you will face that FPs in public do not. But the level of medicine you need to know is certainly much lower as patients come with much simpler issues, usually one issue at a time. That’s how you can see 8-10 patients per hour.
Try using the same approach when managing complex chronics in public setting, 10 different meds, seeing 3-4 different specialists, functional decline, etc and you will soon realise that primary care is not so straightforward.

Please grow up. No need to be bitter that others have more qualifications than you.
Accept that you are more experienced in some areas, while others have more training than you. It doesn’t necessarily mean one approach is better than the other.

Originally Posted by Unregistered

Once again proving that this group is filled with juvenile doctors with childish comments.
“Not even recognized in Malaysia” = “rubbish for becoming a GP”
Okay can.

Having worked in multiple FM settings from public to private, I can assure you that MMed is not rubbish.
It’s only rubbish for those who love simple MBBS style medicine. Manage everything textbook style and refer everything else along. Fudge your way through if you’re not sure.

I’m not saying being a private GP is easy. There are a lot of other challenges that you will face that FPs in public do not. But the level of medicine you need to know is certainly much lower as patients come with much simpler issues, usually one issue at a time. That’s how you can see 8-10 patients per hour.
Try using the same approach when managing complex chronics in public setting, 10 different meds, seeing 3-4 different specialists, functional decline, etc and you will soon realise that primary care is not so straightforward.

Please grow up. No need to be bitter that others have more qualifications than you.
Accept that you are more experienced in some areas, while others have more training than you. It doesn’t necessarily mean one approach is better than the other.

Aiyah. Just let him be ba. There are so many fly by night gp out there also. The reality is also the gp out there will never manage complex pat like in the polyclinic setting.
I have a m.med and whenever I locum, I never feel out of place, infact , I frequently have pat telling me I'm better than the day time ( anchor) doc and they ask me which other day I'm around so they bring their uncle, auntie ,mother to see me too! Lol, I dun dare to tell them...why do I want to make myself busy. Other times the clinic was willingly to pay me 30 bucks an hour extra if I become their regular because many pat in day time ask for me.
I believe the m.med do train me to be a better doctor but hey, no need la cos some gp believe they are way too good for it.

Originally Posted by Unregistered

Many new GPs think that if they know more can do more procedure etc means they will be more successful as GPs in pte. Sure you know more means you can do more. But how you gonna charge? Pte land is all about $$$ and very soon you learn the patients dowan to pay. You charge higher cos you do more then they say too expensive. Plus the time you spend doing procedures. Take consent. Explain etc. Then charge how much? You soon find it is not worth it. Especially when the pts want you charge cheap cheap.
Aesthetics patients will pay. But not T&S lump excision etc. H&L who dare do?

What's T&S, or H&L?

Originally Posted by Unregistered

Aiyah. Just let him be ba. There are so many fly by night gp out there also. The reality is also the gp out there will never manage complex pat like in the polyclinic setting.
I have a m.med and whenever I locum, I never feel out of place, infact , I frequently have pat telling me I'm better than the day time ( anchor) doc and they ask me which other day I'm around so they bring their uncle, auntie ,mother to see me too! Lol, I dun dare to tell them...why do I want to make myself busy. Other times the clinic was willingly to pay me 30 bucks an hour extra if I become their regular because many pat in day time ask for me.
I believe the m.med do train me to be a better doctor but hey, no need la cos some gp believe they are way too good for it.

I guess the question is if the qualification (i.e mmed/or even fellowship in fm) is worth doing? I think everyone agrees that mmed trains a doctor to be more knowledge and competent in managing the comples pts in ops.
However, if the knowledge Is not applicable in the private gp setting (where I guess patients are less complex and service and communication skills probably takes priority as you need to make the patients who feed your ricebowl happy), then is there any point in acquiring all these knowledge?

Just quoting a random example, if a private pt comes in with 3 day history of lower back pain with no radiculopathy or red flags insisting on a MRI scan and specialist referral, you will probably do it right? (Unlike in ops where you will probably say no as it doesn't meet the guidelines). If that is the case, is there still any point revising on the guidelines for MRI scan for lower back pain?(as a mmed doctor will do)

Originally Posted by Unregistered

Aiyah. Just let him be ba. There are so many fly by night gp out there also. The reality is also the gp out there will never manage complex pat like in the polyclinic setting.
I have a m.med and whenever I locum, I never feel out of place, infact , I frequently have pat telling me I'm better than the day time ( anchor) doc and they ask me which other day I'm around so they bring their uncle, auntie ,mother to see me too! Lol, I dun dare to tell them...why do I want to make myself busy. Other times the clinic was willingly to pay me 30 bucks an hour extra if I become their regular because many pat in day time ask for me.
I believe the m.med do train me to be a better doctor but hey, no need la cos some gp believe they are way too good for it.

Let me put to you this question. How much do the patients you sed for the complex stuff at pte clinic pay for consult?

How much?

For that amount do you agree it is worthwhile spending thay extra time or not?

Mind you if the clinic is busy already with simple complaints.

Singaporeans are stingy when it comes to consult fees in pte gp setting
Sometimes better not to know how to manage cos when you know and you knowigly choose not to you feel more guilty. If really dunno. Then you are simply doing your best.

Originally Posted by Unregistered

I guess the question is if the qualification (i.e mmed/or even fellowship in fm) is worth doing? I think everyone agrees that mmed trains a doctor to be more knowledge and competent in managing the comples pts in ops.
However, if the knowledge Is not applicable in the private gp setting (where I guess patients are less complex and service and communication skills probably takes priority as you need to make the patients who feed your ricebowl happy), then is there any point in acquiring all these knowledge?

Just quoting a random example, if a private pt comes in with 3 day history of lower back pain with no radiculopathy or red flags insisting on a MRI scan and specialist referral, you will probably do it right? (Unlike in ops where you will probably say no as it doesn't meet the guidelines). If that is the case, is there still any point revising on the guidelines for MRI scan for lower back pain?(as a mmed doctor will do)

That is just one example of patient asking for MRI back.
How about all the other instances where patient does not outrightly ask for MRI back.
Reading the guidelines is not just for MMed doctors.
Please have some pride in being GP. You are not a referrologist.
If you just anyhow manage, you are no better than a fresh graduate medical student.
(In fact they will probably be better because they would have prepared hard for MBBS)

Originally Posted by Unregistered

Let me put to you this question. How much do the patients you sed for the complex stuff at pte clinic pay for consult?

How much?

For that amount do you agree it is worthwhile spending thay extra time or not?

Mind you if the clinic is busy already with simple complaints.

Singaporeans are stingy when it comes to consult fees in pte gp setting
Sometimes better not to know how to manage cos when you know and you knowigly choose not to you feel more guilty. If really dunno. Then you are simply doing your best.

Bottom line is:
to be a decent GP MBBS... GDFM makes you better prepared... MMed is a bonus



some GPs still struggle with getting the basics right
i have seen questionable management by GPs - you will be appalled why they not yet censured by SMC
and it's not so called "MMed level" rocket science, it's basic medical school pathophysiology and textbook management of simple cases
- giving multivitamin for dizziness (not a case of patient requesting for multivits, and patient does not have anorexia)
- patient has myalgia with simvastatin. switched to fibrate to treat LDL (or worse still, start with fibrate straight away)
- doing uric acid during an episode of gout flare and telling patient he doesn't have gout
- recently read in another forum - very senior GP advised patient with Hb 6+ during health screening to take iron tablets, TCU 1 week. no further evaluation advised.


qualifications do not necessarily make you a better doctor
but neither does years of experience doing the wrong thing
as long as you have the drive to improve and provide at least a basic level of evidence based medicine, it doesn't matter the route (whether you self study, read guidelines, do GDFM / MMed)
there isn't a need to rubbish one route or the other unless you have some serious self esteem issues.

Originally Posted by Unregistered

Let me put to you this question. How much do the patients you sed for the complex stuff at pte clinic pay for consult?

How much?

For that amount do you agree it is worthwhile spending thay extra time or not?

Mind you if the clinic is busy already with simple complaints.

Singaporeans are stingy when it comes to consult fees in pte gp setting
Sometimes better not to know how to manage cos when you know and you knowigly choose not to you feel more guilty. If really dunno. Then you are simply doing your best.

We need to make sure we are discussing about the same point.
Nobody said that MMed is absolutely necessary to be a private GP.
I was simply replying the simpleton who said MMed was rubbish.
It's not rubbish, it's a bonus to prepare you to be a more competent FP.
Whether this competency is beyond the level of a regular neighbourhood GP is another matter.

Qualifications do not necessarily make a good doctor.
But neither does years of experience doing the wrong thing.

Be a decent doctor who does right by your patients.
Offer relevant screening as appropriate. Treat your patients holistically.
Offer evidence based treatment to the best of your ability.
Let's do our best as the first line primary doctors, regardless of our setting.

Originally Posted by Unregistered

That is just one example of patient asking for MRI back.
How about all the other instances where patient does not outrightly ask for MRI back.
Reading the guidelines is not just for MMed doctors.
Please have some pride in being GP. You are not a referrologist.
If you just anyhow manage, you are no better than a fresh graduate medical student.
(In fact they will probably be better because they would have prepared hard for MBBS)

One thing you never do especially in pte practice is to deny a patient an investigation they want and are willing to pay for.

You term this being a referrologist?

There is a reason why guidelines are called guidelines. Because that's what they are. They are no law or rules. Dont believe me?

If a patient insists on an MRI and you deny them thay saying by guidelines they do not deserve one and later on they find another dr who does it an they find a rhabdomyosarcoma in the psoas miscle and they decide to complain to SMC ans sue the first doctor who denied the MRI see what happens when you try to quote guidelines.

Hindsight is 20/20.

There is no medal for saving the "healthcare system" cost and waste. No bonus either. But you run the risk or missing things. How likely? Probably not. But when it is not a common ground you have reached with a patient who wants the test you will be disciplined accordingly as per the hindsight 20/20 guideline.

Wait till you kena. You will change your tune.

Originally Posted by Unregistered

One thing you never do especially in pte practice is to deny a patient an investigation they want and are willing to pay for.

You term this being a referrologist?

There is a reason why guidelines are called guidelines. Because that's what they are. They are no law or rules. Dont believe me?

If a patient insists on an MRI and you deny them thay saying by guidelines they do not deserve one and later on they find another dr who does it an they find a rhabdomyosarcoma in the psoas miscle and they decide to complain to SMC ans sue the first doctor who denied the MRI see what happens when you try to quote guidelines.

Hindsight is 20/20.

There is no medal for saving the "healthcare system" cost and waste. No bonus either. But you run the risk or missing things. How likely? Probably not. But when it is not a common ground you have reached with a patient who wants the test you will be disciplined accordingly as per the hindsight 20/20 guideline.

Wait till you kena. You will change your tune.

Bro. Read properly.
I said that is just one instance of patient requesting for MRI.
What about OTHER instances.
I didn’t say refuse patient who request for MRI.