Tuesday, October 20, 2009

My two-cents worth on the Residency

So I was at the Townhall session yesterday (I still don't understand the use of "Townhall", because it is, 1. A term that invokes thoughts of medieval times and more rural settings, after all, town as opposed to city, both of which are not exactly the kind of setting we find ourselves in today; 2. Contextually irrelevant in its usage - if you want to call it a dialogue session, just call a cat a cat, instead of using some fancy name that makes the entire event sound pretentious and for show; and 3. It just sounds like you're living in an MMORPG - okay, this is just to make a third point because I love multiples of three). Still, let's not harp around too much on the semantics, and get to the meat of the matter.

For those of us who missed out on the "Townhall" session (I should try to be less sardonic in my use of quotation marks), basically, you didn't miss much. You might be better off sparing yourself the kind of negativity and draconian oppression that was the kind of tone resonating throughout the room yesterday. They would have liked for it to be a dialogue session, but basically what it was was a short presentation by one of the MOH people (I presume, because she didn't even introduce herself, how ridiculous) detailing the rather generalised and ill-defined "specifics" of the system (notice the oxymoron), followed by a question-and-answer session with the DMS Himself attempting to answer questions from the floor, which is to say, not at all. Oh, he responded, all right. Responses are different from answers. Especially when your responses deviate from the points raised by the questions, when he responds to questions with more questions (which, as everyone in Medicine knows, is a very unwise thing to do in an examination, but of course, he's not being examined, so who cares?), when you start to notice that he only has a few crafted responses and thus can never really answer any question, and worst of all, when he starts becoming defensive and returning earnest concerns with accusations and all-out haranguing. I half-expected people to be dragged out and incarcerated for expressing their honest views.

In a nutshell, what I surmised from his responses can be summarised into the following points:

1. Like it or not, this is going to happen.
2. They are not forcing the hospitals to do it, but the hospitals themselves say they can do it.
3. If the hospitals cannot cope in carrying out the program, they shouldn't try to bite off more than they can chew, and should only take in a few residents.
4. Despite acknowledging the fact that hospitals may not be able to cope with the change, there is no room for delaying the onset of the programme.
5. Issues about the discrepancies in work scope between residents and HOs are too minuscule (i.e. too "ground-level") for him to worry about. Please forward to relevant department heads.
6. There is no room for compromise, the system has to be perfect at its commencement, otherwise there's no meaning in starting it in the first place.
7. Calling it a residency programme is all for the simple reason so that we have a common language to communicate with the exalted ACGME (the only body he knows has experience in accreditation of postgraduate training, or so he says, so someone please find him some other body that has the same kind of experience, he challenges).
8. Most importantly, we should be HAPPY that this change is being effected, because the old system SUCKS and we cannot go on with the current state of affairs.

I may have missed out some points, but this is the gist of it off the top of my head. In a sentence, he says, "The current system sucks, we are going to change it for the better and we have Americans to help us (so it must be good), so I don't know why you all are asking so many questions and so concerned when you should be elated and thanking me for starting this. I can't really be bothered about all your petty concerns, I'm sure other people can look into it for you, and even if they can't, who cares? BE HAPPY."

He's quite self-contradictory, because on the one hand he says all this, and then interspersed through his sweeping statements he laments, "I didn't want this to be my job either." Okay, so are you unhappy about the change? Or maybe you're just unhappy you have to stand there and listen to our very valid concerns.

At the end of the day, this entire debacle is just a microcosm of the Singapore political system. You can complain all you want, and raise questions and entertain yourself with the illusion of debate, but when the people on top say "This shalt be done", well, you just have to jolly well suck it up and let it be done. Granted, at the end of the day the intention for the change is a good one, and it is inevitable that some will be sacrificed for the "greater good". Just look at the various changes in the Singaporean education system. I don't doubt that change has to happen, and that the aim of this change is good. No one wants to be the grass ground beneath the wheels of change, least of all when this affects your entire future and quality of life. No one wants to be the guinea pigs of yet another great social experiment (and face it, our generation has been the guinea pigs of great social experiments since we have been born, and sometimes there's only so much you can take before the uncertainty of all these experiments becomes intolerable).

The key word here is uncertainty. People are insecure in the face of uncertainty and all they want is reassurance, even the illusion that their concerns are being heard. Being defensive and slamming people who voice their concerns (even the senior clinicians who themselves are heartmovingly championing the causes of the juniors) only goes to prove what kind of a leader you are. We don't expect someone to hold our hand and sing songs to us in the winds of change, but we certainly don't appreciate being cast out with barely a thread to shield us or any comfort from words of encouragement.

So please, if only you could just listen instead of trying to silence what you think are voices of discontent. I think we'd appreciate that so much more.

[If you think I'm being unwarrantedly negative and excessively sarcastic in the above article, let me just say that this is simply my response following the way our concerns were flagrantly disregarded and ground into the dust by an iron fist during the session. When I went for the session, I was hoping for a frank dialogue with concerns being heard and accepted, if not completely answered. But I was grossly disappointed, and I daresay I'm not the only one. This is already a very restrained response.]

Avaris / 10/20/2009 11:35:00 PM

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