How is life as a doctor in Singapore?

Originally Posted by Unregistered

lol. if u hit 60 patient per day consistently, ur bonus gao gao in line with clinic head level Liao
ops. you would have exceed expectation.
as someone say before , there is ops style med and there is m.med level style med. you do m.med style for every case , u die cock stand.
ops trick when doing acute queue is to know what patient want la
mc? dun waste too much time. just give. I straight give 2 days when the adult come in with
headache. NSF sorry, time chit, go back see camp mo. u can wait 2 hours to see me, u can survive going back to see mo.
referral? no need ask this ask that. just write pat keen for referral, refer.
dun talk too much also. some patient see u chatty, keep ask buay paiseh. every skin lesion, white hair, itchy pussy, itchy anus all ask u.
chest pain? cxr, ECG , refer a&e. pat decline, red flag advice given. case close. die when u step out from clinic, sorry, I advice Liao.

chronic patient I work harder la though. my teamlet patient I control chronic gao gao . stable guys out u go , collect meds see u 4 months. save time to counsell those poor control one .
secretly I'm proud I probably save a few heart attack and stroke. I mark down all my rp and junior fp who anyhow. write diet advice given, pls la, I ask patient what did previously doctor tell
u, u got counsel properly or not all come out., still dare to write counsel patient on lifestyle mod.
actually all chronic patient , as long as they are coming back to see u, demonstrate an interest in their heath, whether they take med or increase dose is how u counsel them.

Waiting for the day majority of patients at OPS are poorly controlled chronics.you die c*ck stand

Originally Posted by Unregistered

lol. if u hit 60 patient per day consistently, ur bonus gao gao in line with clinic head level Liao
ops. you would have exceed expectation.
as someone say before , there is ops style med and there is m.med level style med. you do m.med style for every case , u die cock stand.
ops trick when doing acute queue is to know what patient want la
mc? dun waste too much time. just give. I straight give 2 days when the adult come in with
headache. NSF sorry, time chit, go back see camp mo. u can wait 2 hours to see me, u can survive going back to see mo.
referral? no need ask this ask that. just write pat keen for referral, refer.
dun talk too much also. some patient see u chatty, keep ask buay paiseh. every skin lesion, white hair, itchy pussy, itchy anus all ask u.
chest pain? cxr, ECG , refer a&e. pat decline, red flag advice given. case close. die when u step out from clinic, sorry, I advice Liao.

chronic patient I work harder la though. my teamlet patient I control chronic gao gao . stable guys out u go , collect meds see u 4 months. save time to counsell those poor control one .
secretly I'm proud I probably save a few heart attack and stroke. I mark down all my rp and junior fp who anyhow. write diet advice given, pls la, I ask patient what did previously doctor tell
u, u got counsel properly or not all come out., still dare to write counsel patient on lifestyle mod.
actually all chronic patient , as long as they are coming back to see u, demonstrate an interest in their heath, whether they take med or increase dose is how u counsel them.

If it is documented it means it was done. Can't always believe the patients. They like to act blur. Or dont listen to what they dont want to hear. I am sure even your own patients there will be some that other drs ask what did Dr tell you about diet and lifestyle mod and they go Har? Didnt say anything leh.

If the dr bother to document should be that it was done.

If didnt document then not done at all.

Originally Posted by Unregistered

If it is documented it means it was done. Can't always believe the patients. They like to act blur. Or dont listen to what they dont want to hear. I am sure even your own patients there will be some that other drs ask what did Dr tell you about diet and lifestyle mod and they go Har? Didnt say anything leh.

If the dr bother to document should be that it was done.

If didnt document then not done at all.

sometimes i trust the patient more. some of the malaysia /india / pinoy RP really not very good la. They see 45 patients a day and then zhao at 430pm but really anyhow one.
Even local baby MO cannot fully trust. A while back , one of the clinic head commented that a baby Pgy2 MO in his clinic is very good, can see 65 patient a day. I replied thats not good lei, thats worrisome. then he realized the folly of his thinking and shut up.

Originally Posted by Unregistered

sometimes i trust the patient more. some of the malaysia /india / pinoy RP really not very good la. They see 45 patients a day and then zhao at 430pm but really anyhow one.
Even local baby MO cannot fully trust. A while back , one of the clinic head commented that a baby Pgy2 MO in his clinic is very good, can see 65 patient a day. I replied thats not good lei, thats worrisome. then he realized the folly of his thinking and shut up.

You are hard to please. Probably think of yourself very highly best dr at OPS best HOD.
The OPS game is to meet the KPI for volume of patients. Clear the crowd more than contribute to crowd bottle neck. Patient in patient out faster than slower while staying out of trouble. No complaints. No medicolegal issues. If good get some complimentary letters.
As you should know information discrepancy very common. Patients dunno what is good medicine vs good PR skills butter up auntie uncle.

I have never heard of OPS dr get bonus cos he or she got the highest % of patients with HBA1c <7 or BP on target.

Case in point in the general pool, patients dont see back the SAME dr. Not allowed to choose even if they wanted. If want must go FP clinic pay more.
So as an MO in OPS you want that A grade play the game. And do some projects for the OPS. Research project etc.

Your ideals are well meaning and good. But the pragmatic reality is it doesnt pay lah.

Spending time and effort to counsel lifestyle mod? Dont waste time lah. Thankless work. And kena many many ignorant patient say and say till vomit blood nobody appreciates really.

Originally Posted by Unregistered

lol. if u hit 60 patient per day consistently, ur bonus gao gao in line with clinic head level Liao
ops. you would have exceed expectation.
as someone say before , there is ops style med and there is m.med level style med. you do m.med style for every case , u die cock stand.
ops trick when doing acute queue is to know what patient want la
mc? dun waste too much time. just give. I straight give 2 days when the adult come in with
headache. NSF sorry, time chit, go back see camp mo. u can wait 2 hours to see me, u can survive going back to see mo.
referral? no need ask this ask that. just write pat keen for referral, refer.
dun talk too much also. some patient see u chatty, keep ask buay paiseh. every skin lesion, white hair, itchy pussy, itchy anus all ask u.
chest pain? cxr, ECG , refer a&e. pat decline, red flag advice given. case close. die when u step out from clinic, sorry, I advice Liao.

chronic patient I work harder la though. my teamlet patient I control chronic gao gao . stable guys out u go , collect meds see u 4 months. save time to counsell those poor control one .
secretly I'm proud I probably save a few heart attack and stroke. I mark down all my rp and junior fp who anyhow. write diet advice given, pls la, I ask patient what did previously doctor tell
u, u got counsel properly or not all come out., still dare to write counsel patient on lifestyle mod.
actually all chronic patient , as long as they are coming back to see u, demonstrate an interest in their heath, whether they take med or increase dose is how u counsel them.

But nowadays documentation more important than counselling.
E.g your chest pain guy, if you document "return advice/red flags given". You are safe even you didn't actually do it and pt dies.
Conversely, if you did tell him Abt the red flags/return advice but didn't document, he dies of mi, you can still be sued.

I just left the system but when I was mopexing in ops/Ed/im, my seniors/consultants always say documentation is king.
Osteoporosis counselling and bisphosphonate initiation when I was in gm, our documentation is 2 pages (talk Abt all risks, benefits, side effects, alternative, mechanism of action, follow up, failure of treatment etc) but the actual conversation with pt is less than 1 min ("we give you med to strengthen the bone ah, sometimes can cause stomach problem but will give you med also, don't worry")

. We can write so much simply because there is a smart text/template specially designed for such purposes (I guess is to protect us from lawsuits lol)

In Ed there is even a special tutorial for all mopex on "documentation to protect oneself as in what sort of thing we MUST write for certain presenting complaint, but no tutorial on comms skills lol.

Originally Posted by Unregistered

But nowadays documentation more important than counselling.
E.g your chest pain guy, if you document "return advice/red flags given". You are safe even you didn't actually do it and pt dies.
Conversely, if you did tell him Abt the red flags/return advice but didn't document, he dies of mi, you can still be sued.

I just left the system but when I was mopexing in ops/Ed/im, my seniors/consultants always say documentation is king.
Osteoporosis counselling and bisphosphonate initiation when I was in gm, our documentation is 2 pages (talk Abt all risks, benefits, side effects, alternative, mechanism of action, follow up, failure of treatment etc) but the actual conversation with pt is less than 1 min ("we give you med to strengthen the bone ah, sometimes can cause stomach problem but will give you med also, don't worry")

. We can write so much simply because there is a smart text/template specially designed for such purposes (I guess is to protect us from lawsuits lol)

In Ed there is even a special tutorial for all mopex on "documentation to protect oneself as in what sort of thing we MUST write for certain presenting complaint, but no tutorial on comms skills lol.

Exactly. Documentation is king. If you document it is done. If not documented means not done. There is no video recording or audio recording (not allowed due to privacy issues).

Templates is the way to go. Nobody got time to spend 15 minutes talk to patient say many things then spend another 15 min writing long journal entry write like dear diary what the patient and I talked about like scribe. Btw nobody pays for all the time spent on documentation.
So have template. Standard all the things supposed to say all there. Never say also documented. Ass covered. Play the game. The practice is medicine is now dictated by what the lawyers say we should do.

All this stuff theough is never really taught in med school because it would be scandalous. All those idealistic academia are the worst. I pity young drs as they have to learn from their own mistakes and getting into trouble or see their colleagues get in trouble.

There is another pearl. A patient who is happy because you listened to him and did what he wanted he got what he wanted will never complain even if you never followed guidelines and what not. But a patient who is unhappy cos he didnt get what he want even if you follow guidelines CPG protocol whatever will complain and probably cook up things say you rude you arrogant you incompetent stupid etc. Complaint is always bad no matter even if you are right. No complaint is best. But everyone knows if the way you practice is all patient happy one and no complaint means you probably not following guidelines lah

Do be careful. Make sure what you do for patient to make them happy is not illegal. And also not one of those clear cut violate SMC rules one. Also dont cause harm to patient. Otherwise try to keep patients happy as a rule.

Originally Posted by Unregistered

You are hard to please. Probably think of yourself very highly best dr at OPS best HOD.
The OPS game is to meet the KPI for volume of patients. Clear the crowd more than contribute to crowd bottle neck. Patient in patient out faster than slower while staying out of trouble. No complaints. No medicolegal issues. If good get some complimentary letters.
As you should know information discrepancy very common. Patients dunno what is good medicine vs good PR skills butter up auntie uncle.

I have never heard of OPS dr get bonus cos he or she got the highest % of patients with HBA1c <7 or BP on target.

Case in point in the general pool, patients dont see back the SAME dr. Not allowed to choose even if they wanted. If want must go FP clinic pay more.
So as an MO in OPS you want that A grade play the game. And do some projects for the OPS. Research project etc.

Your ideals are well meaning and good. But the pragmatic reality is it doesnt pay lah.

Spending time and effort to counsel lifestyle mod? Dont waste time lah. Thankless work. And kena many many ignorant patient say and say till vomit blood nobody appreciates really.

you sound v jaded leh and yes I agree it doesn't pay. but ok la, hopefully I amass some good karma for my mother and my child. there are days I super Sian also don't want talk and there are days I want to quit too.
u are paid if KPI metrics for hba1c and BP is met. not a lot but can pay for annual car tax and a good staycation. at least for me la. I drive a 2.5l car btw.

u think it's thankless becuase , ahem, u dun know how to counsel. I agree some is hopeless gone case u don't need talk more but a lot will listen if u can speak their frequency

I actually do counsel the full range of stuff for osteoporosis before I start lei. u need skill to bring all the information across succinctly, but yes, including mechanism of action as well.

U guys are totally spot on.

To summarise

Kpi is clear crowd
If got benefit, ur own teamlet patient counsel more.
Documentation is key.
Do counsel for worse case scenario “ return advice given/go ed if condition worsen”

Ops principle is Same as hawker.
The best hawker isnt the one that use the best ingredients and serve the best dish
But some one who knows how to cook fast for the masses, use average ingredients and ensure no food poisoning, without causing long queues.

Hawker = cook fast, good enuff ingredients, avoid queue, no food poisoning
Ops = see fast, basic care, avoid queue, return advice

Originally Posted by Unregistered

U guys are totally spot on.

To summarise

Kpi is clear crowd
If got benefit, ur own teamlet patient counsel more.
Documentation is key.
Do counsel for worse case scenario “ return advice given/go ed if condition worsen”

Ops principle is Same as hawker.
The best hawker isnt the one that use the best ingredients and serve the best dish
But some one who knows how to cook fast for the masses, use average ingredients and ensure no food poisoning, without causing long queues.

Hawker = cook fast, good enuff ingredients, avoid queue, no food poisoning
Ops = see fast, basic care, avoid queue, return advice

there will be the hawker who become so good can guai lan and people will still come back for more. ideally become the cancer surgeon or that interventional radiologist, pple come to your for ur skill to remove the tumour, u how guai lan, they also lan lan. not happy bye lor, good luck with your cancer!

ahaha.
anyway. good news ey for fam med. next month likely to get in approval to be recognised as speciliast liao. yes, I. can set up my chain of family medicine specialis clinict and charge pple 100 bucks per visit. huat ah!

SO, what are the admin jobs available? anyone knows
eg) pharma companies, what is the title to look for