How is life as a doctor in Singapore?

Originally Posted by Unregistered

Medications that are direct to consumer is already happening in most 3rd world countries.
Maybe you can read up on what happened in those countries.

So you want SG to relegate back to being a third world country? LOL.

Originally Posted by Unregistered

So you want SG to relegate back to being a third world country? LOL.

Not in all aspects. One would argue this system of direct to customer sale of pharmaceutical drugs is an improvement over the first world system of prescription only.

Medicines should be open free market.

Originally Posted by Unregistered

Not in all aspects. One would argue this system of direct to customer sale of pharmaceutical drugs is an improvement over the first world system of prescription only.

Medicines should be open free market.

You make statements like these, because you don't know what you don't know. And that's completely understandable as even doctors practising for >20 years can make these mistakes.

Ask your doctor to prescribe you ****** and nitroglycerin at the same time. See what happens to you?

Originally Posted by Unregistered

You make statements like these, because you don't know what you don't know. And that's completely understandable as even doctors practising for >20 years can make these mistakes.

Ask your doctor to prescribe you ****** and nitroglycerin at the same time. See what happens to you?

***** refers to Sildenafil

Originally Posted by Unregistered

You make statements like these, because you don't know what you don't know. And that's completely understandable as even doctors practising for >20 years can make these mistakes.

Ask your doctor to prescribe you ****** and nitroglycerin at the same time. See what happens to you?

Nitrates are a concern for patients taking PDE2 inhibitors. Hypotensive crisis. As it is I dont see many drs warning their patients about informing the A&E dr or paramedics about recent use of PDE2 inhibitor in the event they suffer a heart attack and are brought into hospital for treatment. How many Drs do that? Onus is on the A&E dr to ask before giving nitrates.
These things can be put on the product information or the box labels. Not a big problem. Same with other medications with potential drug interactions.
Another one would be Tamsulosin causing mydriasis and leading to Floppy Iris Syndrome after cataract surgery. How many drs discuss this with their elderly male patients with BPH going for cataract surgery?
I would argue that putting information out there to empower patients is more important because many drs do not know enough. It is not entirely the Drs fault because the breadth of knowledge is just too huge for one person to cover much less go in depth.
Whereas with patients they will google everything about ONE condition or ONE medication because it is relevant to them.

Hi May I know if it’s more likely to get the PEG grant if you were to study medicine in UK than in AUSSIE, or is the process very fair and only the performance in interview counts? Also roughly how many grants are given to AUSSIE grads a year?

Originally Posted by Unregistered

Nitrates are a concern for patients taking PDE2 inhibitors. Hypotensive crisis. As it is I dont see many drs warning their patients about informing the A&E dr or paramedics about recent use of PDE2 inhibitor in the event they suffer a heart attack and are brought into hospital for treatment. How many Drs do that? Onus is on the A&E dr to ask before giving nitrates.
These things can be put on the product information or the box labels. Not a big problem. Same with other medications with potential drug interactions.
Another one would be Tamsulosin causing mydriasis and leading to Floppy Iris Syndrome after cataract surgery. How many drs discuss this with their elderly male patients with BPH going for cataract surgery?
I would argue that putting information out there to empower patients is more important because many drs do not know enough. It is not entirely the Drs fault because the breadth of knowledge is just too huge for one person to cover much less go in depth.
Whereas with patients they will google everything about ONE condition or ONE medication because it is relevant to them.

Not sure if you’re actually a doctor.
But listing out ALL the side effects on the drug packaging usually results in the patient not wanting to take meds. Starting patients on chronic meds usually requires extensive counseling, weighing the risks and benefits of the drug, customizing it to the patients risk profile.
It’s true, my patients love googling all the side effects / adverse reactions, or even stop wanting to take even common meds after being informed about the rare side effects by the pharmacist. It’s up to the doctors to help navigate patients through the sea of information out there.

Sure. Things like random cough cold medications, charcoal pills for diarrhea… no problem putting it on the shelves (they already are). But I would argue that for chronic medications it’s not that easy.

Secondly, it would disadvantage the population segment that has poor health literacy.
Sure, those who are brilliant (and usually higher SES) can google their way through, use UpToDate drug interaction checker, consult their specialist friends on their speed dial at their whim and fancy before taking meds. But many who are not so well educated will struggle to understand probability, risk and statistics (already beautifully displayed by the ongoing misinformation spreading during the pandemic).

Innovation will surely drive change and transformation over the next decade. And yes, some functions of doctors for some patient demographics will no doubt be made obsolete. But there are certain things that cannot be replaced no matter how advanced we are as a country in our technology / education system, even in the foreseeable future.

And btw non-procedural doctors refer to a very huge group…

Imagine rheumatology patients self selecting their choice of DMARDs and self titrating their dose of steroids, choosing to do their monitoring labs at their whim and fancy

Imagine ID / TB patients self selecting their type of HIV / TB drugs from an online store.

Imagine cardio patients self selecting their type of SAPT / DAPT / anticoagulant

Even complex chronic FP patients who are taking 10-12 meds picking and choosing which to eat, adding random meds without understanding the interactions of the drug with other drugs or their 10 other conditions.

All hell will break loose. And by hell I mean the mortuary.
I am all for innovation, but there is something about the therapeutic relationship between a healer and a patient that cannot be replaced by a machine.
It can be through a machine such as remote video consultation, but surely it cannot be reduced to just an algorithm or an online shop like Lazada / Shopee.

Originally Posted by Unregistered

Nitrates are a concern for patients taking PDE2 inhibitors. Hypotensive crisis. As it is I dont see many drs warning their patients about informing the A&E dr or paramedics about recent use of PDE2 inhibitor in the event they suffer a heart attack and are brought into hospital for treatment. How many Drs do that? Onus is on the A&E dr to ask before giving nitrates.
These things can be put on the product information or the box labels. Not a big problem. Same with other medications with potential drug interactions.
Another one would be Tamsulosin causing mydriasis and leading to Floppy Iris Syndrome after cataract surgery. How many drs discuss this with their elderly male patients with BPH going for cataract surgery?
I would argue that putting information out there to empower patients is more important because many drs do not know enough. It is not entirely the Drs fault because the breadth of knowledge is just too huge for one person to cover much less go in depth.
Whereas with patients they will google everything about ONE condition or ONE medication because it is relevant to them.

I literally just saw a patient yesterday who was started on Tamsulosin by someone else.
But he’s a poor blur uncle.
After listening to the pharmacist rant on about the side effects, all he remembered was that the drug “can make my eye red and swollen” and so he collected but did not start the medication at all. He’s not well educated.

Imagine having a computer system / algorithm spit out all these random words at you.
Even if it quotes a very low probability of this side effect, the layman will not be able to understand it and make an appropriate decision.
Is 0.1% very high? Is floppy iris syndrome going to hit everyone?

As I said, not sure if you are a doctor.
If you are a patient, it’s understandable that you would make such grand statements.
Because you only see things from an individual perspective.
As doctors who has seen thousands of patients, some probably more, we have seen the whole spectrum.

Originally Posted by Unregistered

Nitrates are a concern for patients taking PDE2 inhibitors. Hypotensive crisis. As it is I dont see many drs warning their patients about informing the A&E dr or paramedics about recent use of PDE2 inhibitor in the event they suffer a heart attack and are brought into hospital for treatment. How many Drs do that? Onus is on the A&E dr to ask before giving nitrates.
These things can be put on the product information or the box labels. Not a big problem. Same with other medications with potential drug interactions.
Another one would be Tamsulosin causing mydriasis and leading to Floppy Iris Syndrome after cataract surgery. How many drs discuss this with their elderly male patients with BPH going for cataract surgery?
I would argue that putting information out there to empower patients is more important because many drs do not know enough. It is not entirely the Drs fault because the breadth of knowledge is just too huge for one person to cover much less go in depth.
Whereas with patients they will google everything about ONE condition or ONE medication because it is relevant to them.

Have you actually see a patient with an active AMI?
Do you want them to remember what is written on a medication box for a medication they take perhaps once a week, while dyspnoeic and diaphoretic?
Do you actually practise medicine?