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	<title>Dr Cynic and Mr Idealist</title>
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		<title>Patience of patients</title>
		<link>http://acepraeshugyosha.wordpress.com/2008/11/05/patience-of-patients/</link>
		<comments>http://acepraeshugyosha.wordpress.com/2008/11/05/patience-of-patients/#comments</comments>
		<pubDate>Wed, 05 Nov 2008 12:12:48 +0000</pubDate>
		<dc:creator>acepraeshugyosha</dc:creator>
				<category><![CDATA[Doctor's Life]]></category>

		<guid isPermaLink="false">http://acepraeshugyosha.wordpress.com/?p=40</guid>
		<description><![CDATA[I was waiting patiently for the staff of the clinic I&#8217;ll be locuming at today.  It was supposed to open at 630pm but since it was my first time working here, I thought I&#8217;d drop by  mins earlier. I breathed a sigh of relief when I saw that there was no one queueing outside the [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=acepraeshugyosha.wordpress.com&amp;blog=4773631&amp;post=40&amp;subd=acepraeshugyosha&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>I was waiting patiently for the staff of the clinic I&#8217;ll be locuming at today.  It was supposed to open at 630pm but since it was my first time working here, I thought I&#8217;d drop by  mins earlier.</p>
<p>I breathed a sigh of relief when I saw that there was no one queueing outside the clinic, and the clinic was dark (i.e. the staff was having dinner).  Out of the blue, a middle-aged woman walked up to the door, peered in through the glass door, and while acknowledging that the sign said closed, proceeded to pull the door handle.</p>
<p>Huh?  What was she trying to achieve?  Do the dark interior and the &#8220;Closed&#8221; sign somehow suggested that the clinic is actually open and that the staff was just hiding from plain sight?</p>
<p>There was another clinic beside it.  A mum and her small 5 year old kid walked quickly towards the entrance (yeah, similarly this clinic had dark interior and the sign said &#8220;Closed&#8221;) and abruptly stopped behind a bag placed just at the entrance.  In this day and age, one would run away thinking that it was a bomb (for those who have been living in caves all these while, since Sep 11, everyone&#8217;s been vigilant, looking out for anything suspicious [like a bag placed outside a clinic]).  Anyway, the mum correctly identified the bag as a mark left behind by someone who came earlier and putting herself at the top of the queue, as an elderly lady walked towards the bag and identified herself as the owner.  As if following a cue, the little kid started making a fuss,&#8221;Mummy, you shouldn&#8217;t be doing this.. You shouldn&#8217;t be doing this..&#8221; while he stomped his feet on the ground.</p>
<p>Apparently, he was wondering why they were standing outside the clinic almost purposelessly.  The mum proceeded to explain about the queue system as the kid continued to stomp his leg, not happy that they were second in line.</p>
<p>As I watched the scene unfold before me, I grinned while sipping my Coke.  All the while, the lady who was waiting to go into my clinic kept peering back at me, intent at saving her spot, very certain that I was her competitor and will steal her spot at the slightest moment of weakness.</p>
<p>At 630pm, 2 staff walked to the clinic, smiled at the lady and proceeded to open the glass door as they welcomed the patient in and apologised for being on time (instead of being early and thus had to make her wait).</p>
<p>I walked into the clinic behind the staff, stopped outside my room door, smiled at the middle-aged lady and then walked into my room.  I continued to sip my Coke&#8230;</p>
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		<title>Sins of the Investors&#8230; and a Few Good Investors</title>
		<link>http://acepraeshugyosha.wordpress.com/2008/11/03/sins-of-the-investors-and-a-few-good-investors/</link>
		<comments>http://acepraeshugyosha.wordpress.com/2008/11/03/sins-of-the-investors-and-a-few-good-investors/#comments</comments>
		<pubDate>Sun, 02 Nov 2008 16:48:49 +0000</pubDate>
		<dc:creator>acepraeshugyosha</dc:creator>
				<category><![CDATA[Rambling]]></category>
		<category><![CDATA[investors]]></category>

		<guid isPermaLink="false">http://acepraeshugyosha.wordpress.com/?p=35</guid>
		<description><![CDATA[The issue on the losses incurred by investors recently is still being discussed rather furiously.  It baffles me. Investors in general are financially-prudent.  The put in money into financial instruments in the hope of making more money so that they may use the money for old age or to sustain their lifestyle.  All is well [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=acepraeshugyosha.wordpress.com&amp;blog=4773631&amp;post=35&amp;subd=acepraeshugyosha&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>The issue on the losses incurred by investors recently is still being discussed rather furiously.  It baffles me.</p>
<p>Investors in general are financially-prudent.  The put in money into financial instruments in the hope of making more money so that they may use the money for old age or to sustain their lifestyle.  All is well and good&#8230; that is, till they lose money in them.</p>
<p>The contention that is hotly-debated now is whether the investors have been misled or were not given the full picture of the possible financial disasters that might befall them.</p>
<p>I find a group of these investors (not all of them!) hypocritical!</p>
<p>I applaud the investors who admit that it&#8217;s their own fault for taking up the risk, knowing very well that they may lose all their money.  They invested, taking in both the pros and cons that investment may bring.  They admit responsiblity on the chouces that they have made.</p>
<p>However, I am suprememly pissed at the savvy youths (yeah, I have a soft-spot for the elderly) who joined the &#8220;I have been misled&#8221; bandwagon and have the audacity to demand that DBS compensate them 100%!  Are you kidding me.  YOU, yes, the one I just described above, are a coward!</p>
<p>One invests knowing that he may or may not get additional money from the investment.  He further acknowledges that he may lose his money.  So, when the CRO says,&#8221;You may lose your money, but the risk is very low. This is a safe product to invest in.&#8221; what he means is &#8220;You my lose money!&#8221;  How unclear is that?  But, they will continue along the lines of,&#8221;But the CRO has downplayed the risk that was involved.&#8221;  BS! He did not downplay the risk &#8211; he did mention that you may lose your money.  So what if he had emphasised the risk that it is low &#8211; you can still lose money.  Even if the risk is o.1%, you STILL CAN LOSE MONEY, ALL OF THEM &#8211; how difficult is it to comprehend?</p>
<p>The problem is, people make financial decisions based on either fear or greed (most of the time, greed).  Thus, when one makes the decision to invest, he knows the risk, but is optimistic that he won&#8217;t be so unlucky so as to lose all his money.  And so, he happily claims his dividends and returns (Yippee&#8230;), till disaster strikes.  While still holding on to whatever returns he has already claimed/withdrawn (if he had), he cries foul!  That, my friend, is the typical investor.</p>
<p>When I read books on investments, the key point authors bring across is that you stand to gain, but you stand to lose too.  So, it&#8217;s about minimising risk.  2 points here:</p>
<ol>
<li>Successful investors do lose money investing, but they learn and move on.</li>
<li>You can only minimise risk &#8211; not eliminate risk.  Even keeping money in your own home has a risk of being stolen on burnt in a fire!</li>
</ol>
<p>However, these investors who lost money instead blames on everyone else but themselves.  Even if they do say that they are to be blame as well, they still wish to be compensated substantially (basically saying that their fault is minimal, if any).</p>
<p>I&#8217;m curious why this peculiar behaviour arises.  So, I offer a few but the list is not exhaustive:</p>
<p>1.  They&#8217;ve lost all their savings.</p>
<p>My commments:  The financial-prudence that this group demonstrates through investing is negated by stupidity.  a) NO ONE  invests all their money &#8211; you need at least 6-12 months of your monthly income/expenditure in cold hard cash to tide you through the hard times should your investment go southwards; and b) NO ONE invests all their money in 1 instrument &#8211; has the phrase &#8220;diversify your investments (and thus your risks)&#8221; gone obsolete in this day and age?</p>
<p>2. They feel cheated.</p>
<p>My comments: People only hear what they want to hear.  When one invest, greed is he motivating factor.  So, when the CRO says,&#8221;You may lose your money, but the risk is very low. This is a safe product to invest in.&#8221; what they here is &#8220;&#8230;the risk is very low. This is a safe product to invest in.&#8221;  Selective hearing results in selective memory that ultimately results in one believing that one was misled!</p>
<p>3. They do not want other investors to be cheated.</p>
<p>My comments: BS!  Everyone talks about themselves and how they lost, not about others.  So, this argument goes down the drain.</p>
<p>4. They were really dumb and were really duped.</p>
<p>My comments:  I believe this is more applicable to retired 60-year-olds who can hardly fill up an application form or who are not highly-educated.  They are vulnerable.  Their position is made worse by the fact that they tend to belong to the very group of people who need the extra cash.  As such, even if they were given the slimmest chance to earn more money, they&#8217;ll take the risk.  So, a 3-5% risk is extremely good odds for them.  Yes, for these people, I pity them because they may really have made a mistake.  I have to qualify myself &#8211; I assume that EVERYONE READS THE T&amp;C AND FINE PRINTS.  But these people are usually disadvantaged in that they can&#8217;t, and so they hold firmly to what the CRO says.  And coupled with the low income that they have and the possibly lower understanding of the risk, they make decisions without much hesitation.</p>
<p>But, if you&#8217;re a 30-50 year-old executive or professional who has a job, and actually has enough money to invest, but was just too lazy to read and too greedy to readily agree, then you deserved it!</p>
<p>5. Denial</p>
<p>My comments: 4D has possibly more than 90% chance of losing, yet people still spend money on them.  Casino too.  But some people actually win big sums.  So, when one is presented with an investment opportunity where the risk is minimal, they expect to win too.  This losing is something that no investor count on (be realistic: if you think you will lose, you won&#8217;t invest in the first place).</p>
<p>Some people may wonder why I have such a grudge and seemigly no mercy for people who have lost their money.  The answer is: life&#8217;s unfair, so move one with it.</p>
<p>1. They have been told of the risk, and even bolded in the fine prints, yet they CHOOSE to ignore it, and blame external factors for their losses.</p>
<p>2. They stupidly CHOOSE to invest substantial amounts to one instrument rather than diversify.</p>
<p>3. They stupidly CHOOSE to invest ALL their money without even saving any.  Yes, more money invested can mean more gains, but it can also mean more losses.  Seriously, has no one heard of the phrase &#8220;the bigger you are the harder you fall&#8221;?</p>
<p>4. They CHOOSE to blame others but themselves, and thus, in the process, do not and will not learn from this incident.  And chances are will repeat this in future when the financial situation is rosy again.</p>
<p>5. They CHOOSE to believe that the economy will forever grow and never go in cycle, and that they can NEVER lose money.</p>
<p>6. They CHOOSE to believe whatever the CRO said, lock, stock and barrel.  Look, the CRO is there to sell a product offered by his company.  He may get a comission should you agree to invest in the product.  I don&#8217;t blame the CRO &#8211; he needs the commission and he is obliged to sell his company&#8217;s product (do you tell customers that you think your company&#8217;s products suck?!).  One must understand that the CRO is not their personal financial planner.  They do not sit down with you and discuss you financial goals in its entirety the way a CFP would.  Thus, while they may have a vague picture of what kind of investor you are (low-, med- or high-risk taker), they won&#8217;t know about the loans you have to pay, the endowment you have for your kids, the cash you have (or lack of).  They&#8217;re just there to sell a product offered by their company that has told them how good the product is!</p>
<p>So, it&#8217;s about choices.  These investors chose the above (and others which I might have missed).  But when reality smacks them in the face, they can&#8217;t handle the truth.  They will go through the stages of grief:</p>
<p><strong>Denial</strong> &#8211; <em>It&#8217;s not possible.  How can I lose all my money?  It can&#8217;t be me.  It&#8217;s not fair!</em></p>
<p><strong>Anger</strong> &#8211; <em>It&#8217;s DBS&#8217;s fault.  The CRO misled me.  The government better do something or else.  All banks are out to cheat me. #@$&amp;</em></p>
<p><strong>Bargaining</strong> &#8211; <em>Ok, fine. If you can&#8217;t give me everything, just give me something.  Or at least punish DBS.  Or something.  Just something to appease me&#8230; Something&#8230;</em></p>
<p><strong>Depression</strong> &#8211; <em>Sigh.  The government don&#8217;t hear our plight.  DBS is using its muscle to ignore us and shove us aside.  We can&#8217;t do anything. </em></p>
<p><strong>Acceptance</strong> &#8211; <em>Hmm&#8230; I doubt they will get to this stage.  They will never accept anything less than what they want!</em></p>
<p>They will never be satisfied till something happens.  And, mind you, it&#8217;s not for the purpose of the greater good, but for the selfish reason.  Yes, you have kids to send to school and mouths to feed, but you should learn from your mistake.  Your children should know what grievous error you made and they should vow to be better than you.  Don&#8217;t be a coward and run away from a lesson &#8211; face up to it.</p>
<p>Why should the government have to use the taxpayers&#8217; money to bail you out?  Why should DBS lose revenue from having to pay you back, making DBS shareholders lose capital and dividend gains?</p>
<p>You took the risk, now you feel the consequences of the chouces that you make.  Don&#8217;t shy from investing &#8211; just be a better investor next time&#8230;</p>
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		<title>The hapless Singaporeans</title>
		<link>http://acepraeshugyosha.wordpress.com/2008/10/27/the-hapless-singaporeans/</link>
		<comments>http://acepraeshugyosha.wordpress.com/2008/10/27/the-hapless-singaporeans/#comments</comments>
		<pubDate>Mon, 27 Oct 2008 04:05:36 +0000</pubDate>
		<dc:creator>acepraeshugyosha</dc:creator>
				<category><![CDATA[Rambling]]></category>

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		<description><![CDATA[The recent and current worldwide economic turmoil caused by the greed of the new-age bankers who seek only THEIR own fortune has sent ripples to even the economically-sound city of Singapore. Singaporeans can be considered quite money-wise.  They invest in stocks, trust funds and treasury notes and dabble in options and forex trading.  It is [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=acepraeshugyosha.wordpress.com&amp;blog=4773631&amp;post=30&amp;subd=acepraeshugyosha&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>The recent and current worldwide economic turmoil caused by the greed of the new-age bankers who seek only THEIR own fortune has sent ripples to even the economically-sound city of Singapore.</p>
<p>Singaporeans can be considered quite money-wise.  They invest in stocks, trust funds and treasury notes and dabble in options and forex trading.  It is a Singaporean thing &#8211; to make money at all costs.  However, the economic crisis resulted in many losing their hard-earned money in myriad of financial instruments, such as the DBS notes (which invested in the forsaken Lehman brothers).</p>
<p>I read an article yesterday about how a wheelchair-bound individual could stand to lose the $200,000 of insurance payout that he put into his investment (2.5y maturity).  Well, the fact that his story was reported in the New Paper meant that he is desperate for help, which is why he was fine with his story being published in a semi-tabloid paper.  And I applaud the writer and the photographer &#8211; portraying the fella as a hapless person, who was not only handicapped but can also be financially crippled (pun intended).</p>
<p>My sentiments when I read the article: serve you right; have you not heard of caveat <em>emptor</em>?</p>
<p>One may wonder why I develop no mercy or sympathy for these people who need a helping hand.</p>
<p>During the late 1990s and early 2000s, Singapore had a spate of bucketshops tricking people.  These people literally trick you into parting with your money without even revealing anything.  My dad got tricked of over $100,000 by a company claiming to be associated with the government.  When he and others called out for help, no one could help, not CASE and not the MPs, because the money has been wasted in the market.  There was an expose on the bucketshops resulting in the clampdown of all such operations, but the losers remained losers.  They did not get their money back no matter how much they pleaded for help.  My dad spent another $5000 employing a lawyer who was purported to be good at persecuting such companies, but in the end, he too faded away.</p>
<p>My dad and I learnt a great deal from that experience.  It was a lesson from the school of hard knocks.  And we blame ourselves for being foolish, and promised to never act so irrationally and foolishly again.  Fast-forward to today &#8211; we&#8217;re just fine.</p>
<p>So, now ask me again why I have no sympathy for the guy in the wheelchair?  It&#8217;s cos he deserves to be taught a lesson.  He should have read the fine prints and should have the common sense not to put ALL his money in one basket (what kind of an idiot is that?).  At least the banks did wrte the risk down in fine prints &#8211; the bucketshops that cheated my dad, didn&#8217;t!</p>
<p>And all the blokes who, like the wheelchair fella, believed that they can only gain and not lose money in the investments ought to be knocked on the head! What the hell were they thinking?  There is no such things as 100% risk free.  Even deposits in large established banks can be defaulted &#8211; Northern Rock, Lehman, etc, such that the Singapore government had to assure the citizens that all deposits will be protected!</p>
<p>So, whose fault is it?  It&#8217;s really theirs.  Economic turmoil is just part and parcel of the world economic cycle.  The economy cannot be perfect all the time &#8211; it&#8217;ll have to crash some time.  But these fellas actually believed that the economy is invincible.  If you ask me, idiots with that mentality deserved what they got.</p>
<p>But alas, the gullible wheelchair bound person will not lose all his money as his principal amount of $200,000 is guaranteed as long as he keeps the investment to term.  There goes a good lesson down the drain.  I&#8217;m pretty sure the fella is going to invest his money on something else <em>safer</em> in future, and he will make the same mistake again and he will plead again and be given the lifeline again&#8230;  He may never learn.</p>
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		<title>Thank you&#8230; sincerely&#8230;</title>
		<link>http://acepraeshugyosha.wordpress.com/2008/10/24/thank-you-sincerely/</link>
		<comments>http://acepraeshugyosha.wordpress.com/2008/10/24/thank-you-sincerely/#comments</comments>
		<pubDate>Fri, 24 Oct 2008 13:43:26 +0000</pubDate>
		<dc:creator>acepraeshugyosha</dc:creator>
				<category><![CDATA[Stupid patients]]></category>

		<guid isPermaLink="false">http://acepraeshugyosha.wordpress.com/?p=28</guid>
		<description><![CDATA[I just saw a patient who came in complaining of a laceration over this thumb, which he sustained while cutting meat with his cleaver. It was a deep laceration, and the X-ray showed an undisplaced fracture over the distal phalanx of the thumb. The patient appeared calm, but it&#8217;s the accompanying woman that was overly [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=acepraeshugyosha.wordpress.com&amp;blog=4773631&amp;post=28&amp;subd=acepraeshugyosha&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>I just saw a patient who came in complaining of a laceration over this thumb, which he sustained while cutting meat with his cleaver. It was a deep laceration, and the X-ray showed an undisplaced fracture over the distal phalanx of the thumb.</p>
<p>The patient appeared calm, but it&#8217;s the accompanying woman that was overly anxious.  I&#8217;m not sure whether she was his sister or an overzealous girlfriend.  Even before I inspected the wound, she already fired a salvo of questions, expecting me to be able to answer them before I&#8217;ve even done my full assessment.  Fair enough &#8211; patients and their relatives are anxious, so I let it slip.</p>
<p>After the X-ray, I told the patient that I&#8217;d avulse his already lacerated nail, repair the nailbed and stitch up his wound.</p>
<p>This woman looked at me suspiciously and remarked: why do you want to do that; isn&#8217;t it painful?  I looked at her, calmed myself, and assured her that I&#8217;ll give the patient a digital block to numb the finger before I do any work on it.  I further assured her that the thumb injury usually will heal very well.</p>
<p>She looked at me disbelievingly, as though 1) doctors are generally inhumane and thus would never have though of giving the digital block unless SHE reminded us and 2) that there is no way in hell that we can numb the hand and do a painless procedure.  She left, looking unsatisfied, while the patient and her mum were thankful that I will be fixing the patient&#8217;s problem.  She did say thank you &#8211; the sarcastic kind, as though to say &#8220;I&#8217;ll reserve my sincere thanks if and only when you&#8217;ve done your supposed magic.&#8221;</p>
<p>I can only hope she did not realise the cogwheels running in my brain, generating the &#8220;I think you&#8217;re so fucking stupid&#8221; look&#8230; sincerely for her&#8230; really&#8230;</p>
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		<title>The Demise&#8230;</title>
		<link>http://acepraeshugyosha.wordpress.com/2008/10/15/the-demise/</link>
		<comments>http://acepraeshugyosha.wordpress.com/2008/10/15/the-demise/#comments</comments>
		<pubDate>Wed, 15 Oct 2008 05:50:23 +0000</pubDate>
		<dc:creator>acepraeshugyosha</dc:creator>
				<category><![CDATA[Doctor's Life]]></category>

		<guid isPermaLink="false">http://acepraeshugyosha.wordpress.com/?p=26</guid>
		<description><![CDATA[I&#8217;ve been working in the ED for almost a year, and have been exposed to thousands of patients, both in the hospital and during locum. And today, I was doing some relatively light locum work at the clinic, when it hit me suddenly &#8211; I began to think that everyone who comes through my door [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=acepraeshugyosha.wordpress.com&amp;blog=4773631&amp;post=26&amp;subd=acepraeshugyosha&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>I&#8217;ve been working in the ED for almost a year, and have been exposed to thousands of patients, both in the hospital and during locum.</p>
<p>And today, I was doing some relatively light locum work at the clinic, when it hit me suddenly &#8211; I began to think that everyone who comes through my door is a liar who has an agenda.  My God, I&#8217;m turning into House (the character in House M.D.).  I distrust all their complaints and believed that they are here just to get a day off simply because doctors are meant to be trusting and sympathetic.</p>
<p>I have lost all hope in my patients.  The disillusionment has come to a point where I&#8217;m just going through the motion just for the sake of it or just for an intellectual challenge.  It&#8217;s no longer about the patient.</p>
<p>I&#8217;m not sure what happened to cause this sudden change in attitude.  Maybe I&#8217;m burnt out or maybe I&#8217;m just too tired and exhausted.  Or maybe it&#8217;s because I feel that the world is not fair.  As an ED physician in a busy tertiary hospital, my off days are limited.  Even when I&#8217;m sick, I do not go on MC because 1) my colleagues would suffer, and 2) going on MC would automatically mean that my off day would be revoked, to be given to the person who was called back on his off day.</p>
<p>So, while people in general are entitled to 14 days of MC in addition to their allocated off days, I&#8217;m entitled to 3-4 rest days per month, inclusive of my sick days.  That works out to be 48 off days a year (including sick days) &#8211; others get 96 days minimum, because they don&#8217;t have to work during public holidays but we may have to.  Even though we&#8217;re entitled to 28 days of annual leave a year, we hardly get to use all of them because we are only allowed to take 14 days of leave every 6 months (and that is inclusive of Saturdays and Sundays &#8211; which do not count towards our leave).  So, while a normal office worker with 28 days in effect gets 28 days + at least 12 extra days if their leave cross weekends. </p>
<p>Sigh.  I guess it&#8217;s this perceived inequality that makes us doctors really irritable and hold a grudge against the patients.  You guys have it easy and you still wanna get an MC.  Try taking over my work at the ED for a week and I&#8217;ll bet you&#8217;ll either quit or die trying&#8230;</p>
<p>Looking for the doctor? Sorry, we&#8217;re dead&#8230;</p>
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		<title>Busy month&#8230;</title>
		<link>http://acepraeshugyosha.wordpress.com/2008/10/06/busy-month/</link>
		<comments>http://acepraeshugyosha.wordpress.com/2008/10/06/busy-month/#comments</comments>
		<pubDate>Sun, 05 Oct 2008 21:16:40 +0000</pubDate>
		<dc:creator>acepraeshugyosha</dc:creator>
				<category><![CDATA[Rambling]]></category>

		<guid isPermaLink="false">http://acepraeshugyosha.wordpress.com/?p=21</guid>
		<description><![CDATA[October will be a busy month for me. I&#8217;ll be on course on the 6th and 7th, for which there will be a test at the end of it. My Strategy Management exam is on the 18th and the CSCS exam is on the 26th. I sometimes wonder why I put myself into these circumstances. [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=acepraeshugyosha.wordpress.com&amp;blog=4773631&amp;post=21&amp;subd=acepraeshugyosha&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>October will be a busy month for me.</p>
<p>I&#8217;ll be on course on the 6th and 7th, for which there will be a test at the end of it.</p>
<p>My Strategy Management exam is on the 18th and the CSCS exam is on the 26th.</p>
<p>I sometimes wonder why I put myself into these circumstances. It does seem that I frequently bite off more than I can chew.  But I continuously psyche myself and convince myself that I can do it &#8211; that I can stretch myself.  It can seem inhuman at times, and the preparations leading up to these events often take their toll, but I&#8217;d do the same thing in future.  It&#8217;s recursive and predictable.</p>
<p>Maybe, deep inside, I see a need to prove myself &#8211; to see my own mettle.  Or maybe I&#8217;m just a glutton for punishment.  Whatever the reason, I continuously subject myself to high amounts of stress&#8230; and I&#8217;m beginning to feel tired, really tired.</p>
<p>I&#8217;ll turn 30 on the 19th.  It&#8217;s a new phase of my life.  I&#8217;m confident that I&#8217;ll be able to manage my life better.  And by better, I don&#8217;t mean less of these crunch of activites &#8211; no, I have to do them&#8230; But maybe, I&#8217;ll be able to cope better.  The city never sleeps and the rat race never ends&#8230; the winner is the one who paces himself through his life, not the one who sprints in the beginning and crawls the rest of the way&#8230;</p>
<p>Yeah it&#8217;s about seeing the long-term&#8230; Guess I was trying to sprint afterall.  Go slow, be consistent&#8230; that&#8217;s the hallmark of a winner&#8230; or at least a sustainable one.  As much as everyone wants to be on top of his game, no one can do that all the time &#8211; he&#8217;ll be burnt-out.  It&#8217;s not about slacking or opting for second best, but it&#8217;s about consistency, about going the distance, abot surviving in the long haul.</p>
<p>The cliche saying &#8220;<em>Don&#8217;t win the battle only to lose the war&#8230;</em>&#8221; may seem apt at this point.  But my question is: if you don&#8217;t win the battles in the first place, how would you expect to win the war?</p>
<p>See, you not only need to win the battles, but you gotta last long enough to win most, if not all of the battles, to win the war.  Consistency is the answer.  And to be consistent, I must pace myself so that I don&#8217;t get too burnt-out to continue to fulfill my long-term goals, to win the war.</p>
<p>That will be my lesson as I turn 30&#8230;</p>
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		<title>Confidence Lost&#8230;</title>
		<link>http://acepraeshugyosha.wordpress.com/2008/10/04/confidence-lost/</link>
		<comments>http://acepraeshugyosha.wordpress.com/2008/10/04/confidence-lost/#comments</comments>
		<pubDate>Sat, 04 Oct 2008 11:32:48 +0000</pubDate>
		<dc:creator>acepraeshugyosha</dc:creator>
				<category><![CDATA[Doctor's Life]]></category>

		<guid isPermaLink="false">http://acepraeshugyosha.wordpress.com/?p=17</guid>
		<description><![CDATA[Working as an ED physician is an enjoyable career &#8211; you get to see a myriad variety of cases, you challanege yourself to be the best simply because you&#8217;re at the frontline, and you develop as a person in the way you communicate with another human being in all kinds of circumstances. At the very [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=acepraeshugyosha.wordpress.com&amp;blog=4773631&amp;post=17&amp;subd=acepraeshugyosha&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>Working as an ED physician is an enjoyable career &#8211; you get to see a myriad variety of cases, you challanege yourself to be the best simply because you&#8217;re at the frontline, and you develop as a person in the way you communicate with another human being in all kinds of circumstances.</p>
<p>At the very same time, it is a stressful and demoralising job.  It is so busy at the ED, we occasionally do not have our breaks or time to even take a leak.  Of course, patients don&#8217;t care about this &#8211; they only care about themselves.  If they do know, they would blame the system for not being nice to us, when in fact, little do they realise that they sometimes are the source of our problems.</p>
<p>But what worries us is the fact that Singaporeans, following the trend of more developed countries, are beginning to be less forgiving and more litigious.  They see the doctor not as someone who is trying to help, but someone to distrust and attack at the smallest opportunity.</p>
<p>Many factors contribute to this:</p>
<ol>
<li>The unsatisfactory state of the PUBLIC healthcare system has made the public so frustrated that they will take every opportunity to punish it.</li>
<li>The internet has spawned the &#8220;intelligent and informed patients and relatives&#8221; who believe that reading from the is equivalent to going through 5 years of medical school and years of medical experience.  Thus, instead of using the information to clarify and make collaborative decision with the doctor, they use the information on the net as a weapon to use against the doctor, or as a gauge to see how good the doctor is, or just to plain disprove and disagree with the doctor.</li>
<li>With dwindling loyalty towards doctors, patients would go doctor-hopping.  And they would continue hopping till they find a doctor who agrees with them, or who would given them ammunition to sue their previous doctors.</li>
</ol>
<p>I sound so pessimistic and cynical, don&#8217;t I?  That&#8217;s what working in the public ED does to you.</p>
<p>I used to be a confident ED physician who is proud of my work.  I am proud of my work because I know that I&#8217;m giving my very best to my patients.  Thus, it gets disheartening when you get a complain letter from your patients for the smallest reason.</p>
<p>One daughter, who was not there with her father when he was seen at the ED till the time he was discharged, complained that I did not update her on his condition, and added that I was wrong for not admitting her dad who had fallen.  She has, in effect, questioned my judgement&#8230;<em> in absentia</em>.</p>
<p>Another was about a girl who fell from the 2nd storey and sustained a fracture of the distal fibula.  I had discussed with my attending regarding the case, and we had both agreed that she can be discharged with a cast and to be reviewed by the Orthopaedics surgeon within the week.  We further informed the girl&#8217;s brother that there may be a possibility that she may need to undergo surgery at a later date after the review by the surgeons.  True enough, the girl was admitted when she was reviewed by the Orthopaedics surgeon.  As before, the father, who, as you&#8217;ve remembered, was not present that day, was angry that she needs to undergo surgery.  The intern called me while I was resting and insisted that I speak to the father.  The first words out of the father&#8217;s mouth when he got on the line: &#8220;I don&#8217;t care what you have to say&#8230;&#8221;  I should have just hung up the phone then since he didn&#8217;t care about explanations!  But I listened to his grievances, told him the story all over again and apologised for not updating him in his absence.  Of course, I wish I could whack his son (the girl&#8217;s brother) till his half-dead for not updating his dad!</p>
<p>I&#8217;m not saying that you cannot clarify with the doctor, but don&#8217;t try to vent your anger to the nearest person when you don&#8217;t have the full information.</p>
<p>These and other events have made me lose confidence in my own judgement.  I consult my attending more frequently, even when I&#8217;m right in the first place 9 out of 10 times.  The price of lost confidence is the healthcare system.  As doctors become more discouraged to practice medicine, the healthcare system would only start to deteriorate, and it would spiral into a vicious cycle.</p>
<p>If I can try to see how I can improve my patientcare, why can&#8217;t patients and their relatives see their role in this?</p>
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		<title>Singaporeans: the health sector woes&#8230;</title>
		<link>http://acepraeshugyosha.wordpress.com/2008/10/04/singaporeans-the-health-sector-woes/</link>
		<comments>http://acepraeshugyosha.wordpress.com/2008/10/04/singaporeans-the-health-sector-woes/#comments</comments>
		<pubDate>Sat, 04 Oct 2008 10:58:37 +0000</pubDate>
		<dc:creator>acepraeshugyosha</dc:creator>
				<category><![CDATA[Doctor's Life]]></category>

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		<description><![CDATA[The number of complaints the ED received has increased exponentially.  It&#8217;s a systemic problem &#8211; one that the government is trying hard to address to an ever-impatient society.  The healthcare system is a valuable and limited resource, but Singaporeans have come to accept that the government will pander to all their whims and fancies. Traditionally, [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=acepraeshugyosha.wordpress.com&amp;blog=4773631&amp;post=15&amp;subd=acepraeshugyosha&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>The number of complaints the ED received has increased exponentially.  It&#8217;s a systemic problem &#8211; one that the government is trying hard to address to an ever-impatient society.  The healthcare system is a valuable and limited resource, but Singaporeans have come to accept that the government will pander to all their whims and fancies.</p>
<p>Traditionally, the ED, as the name implies, is meant to cater to medical and surgical emergencies and accidents.  However, Singaporeans are abusing the ED for the most minor diseases like a rash or a cold.  The $75 would not deter them.  There are many motives for the abuse of ED:</p>
<ol>
<li>They feel that ED physicians are more qualified than the many equally-qualified general practitioners and family physicians who can attend to their minor issues.</li>
<li>They wish to abuse the system by demanding for unnecessary X-rays and tests which would cost them a hand and a leg should they request for these tests from their GP or other private hospitals.</li>
<li>They own the Civil Service Card which entitles them to free medical treatment at the expense of taxpayers.  So, yeah, dumping old, disabled parents while they go on the extended vacation is a perfectly valid reason &#8211; I mean, if you only have to pay between $1 to $6 per day in the A-class ward, and need not answer the incessant phonecalls by the hospital to discharge your disabled relative, heck, why not?</li>
</ol>
<p>Of course, there are the valid cases &#8211; the sick ones who require our attention.  What pisses us doctors the most is the fact that the other non-emergency cases are hogging precious time which could be better spent on the sicker patients.</p>
<p>Why should that be the case? Just take your time with every patient &#8211; isn&#8217;t that what every patient wants?  Attention from the doctors&#8230;</p>
<p>Of course&#8230; that&#8217;s what every patient wants &#8211; for themselves.  If you are number 10 in the queue, you&#8217;d be cursing at the doctor for seeing the patients in front of you slowly, but would hog the doctor when you turn comes.  How typical of a Singaporean!!!</p>
<p>Then, instead of seeing how they contribute to the problem, they would see the system as the problem.  Get more doctors, open more rooms, employ more nurses, make the system efficient&#8230; BUT&#8230; don&#8217;t increase the ED fee&#8230;</p>
<p>Huh? You want better service but you&#8217;re not willing to pay more&#8230; But you would not bat an eyelid to pay more for the first class air ticket or that Sony HDTV in your living room? It doesn&#8217;t make sense, does it?</p>
<p>It&#8217;s a right for every Singaporean to receive affordable healthcare.  Yes, but you&#8217;re missing the point here &#8211; you have the right to receive BASIC and NECESSARY healthcare, something which you can get from your GPs and polyclinics.  If you come to ED with beliefs that we are better, or to get that tests, then pay us more and don&#8217;t complain about the long wait since you&#8217;re part of the problem to start with!</p>
<p>Of course, at this point, they would start taking the moral high ground and start tsk-tsking at us, saying how healthcare workers nowadays are mercenaries and do not work with the patients&#8217; interest at heart!</p>
<p>If you want that first class ticket, so do I. If you want to watch movies with the Sony HDTV, so do I!  So, why is it that I need to sacrifice my own earnings for you, when you would push for a price increase in your own products or services so that you can get that fat bonus at the end of the year!?</p>
<p>Not too long ago, the government published the top 10 earners in Singapore in an attempt to justify the increase in ministers&#8217; salaries.  2 points are worth noting:</p>
<ol>
<li>There are no doctors in the list of the top 10 earners.</li>
<li>Even though, a minister&#8217;s job, like a doctor&#8217;s, is about serving people, and mind you, the public did raise this point, the government went ahead with the salary increase. It justified this by saying that the salary increase is inevitable and necessary so that we can attract and retain the best minds in the government service, and so as to prevent corruption.  Going by this reasoning, doctors&#8217; pay should rise too (that would of course necessitate an increase in healthcare spending).</li>
</ol>
<p>I digress.</p>
<p>The point is, we hope that people would be more sensible and understanding.  The healthcare system around the world is overused.  The countries that give free healthcare to their people charge very high taxes.</p>
<p>Singaporeans must start to realise that they cannot have the cake and eat it at the same time.  If you want to pay cheap taxes, then you have to pay for your healthcare.  If you still don&#8217;t want to pay a lot, then don&#8217;t complain.  If you wish to complain, pay more and go to a private hospital where you will be attended to stat.</p>
<p>Case in point: I just saw a patient last night who came from East Shore Hospital.  He sustained a laceration on his thumb, a small 1cm cut that required suturing.  ESH said they would do it&#8230; at a cost of $300.  For $75, I gave him the 3 stitches he needed and politely listened to his rambling about how ridiculous ESH was charging him&#8230;</p>
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		<title>I&#8217;m lost&#8230;</title>
		<link>http://acepraeshugyosha.wordpress.com/2008/10/04/im-lost/</link>
		<comments>http://acepraeshugyosha.wordpress.com/2008/10/04/im-lost/#comments</comments>
		<pubDate>Sat, 04 Oct 2008 10:26:09 +0000</pubDate>
		<dc:creator>acepraeshugyosha</dc:creator>
				<category><![CDATA[Rambling]]></category>

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		<description><![CDATA[It&#8217;s a beautiful Saturday evening, and it&#8217;s my sleeping day after slogging through the night before.  IT&#8217;s one of the rare moments where I don&#8217;t have anything scheduled, and I&#8217;m just enjoying the evening breeze&#8230; and I feel LOST!  For the first time in a long time, I have nothing to do and I feel [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=acepraeshugyosha.wordpress.com&amp;blog=4773631&amp;post=12&amp;subd=acepraeshugyosha&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>It&#8217;s a beautiful Saturday evening, and it&#8217;s my sleeping day after slogging through the night before.  IT&#8217;s one of the rare moments where I don&#8217;t have anything scheduled, and I&#8217;m just enjoying the evening breeze&#8230; and I feel LOST!  For the first time in a long time, I have nothing to do and I feel out of place.</p>
<p>I&#8217;m just lazing around watching Anthony Bourdain and Curtis (<em>Take Home Chef</em>), and my mind is racing about what I should be doing.  Well, there&#8217;s the articles I need to read for my Strategy Management and CSCS exams, but, part of me would just like to enjoy this small moment of luxury, of nothingness, of no worries.</p>
<p>I feel lost, but I feel good.  It&#8217;s been a while since I&#8217;ve truly enjoyed the evening breeze.  I&#8217;m resisting the urge to just go out and have a drive, and perhaps a dinner on my own&#8230; Yeah, that sounds good.  My alone time as I wonder through town; something I used to do an enjoy doing.  It&#8217;s ME&#8230; being alone.</p>
<p>Enjoying my time alone doesn&#8217;t mean I enjoy being lonely.  It just means that I&#8217;d just like to have some ME time&#8230; for now&#8230;</p>
<p>Maybe I&#8217;m not that lost afterall&#8230; maybe, I just found myself&#8230; again&#8230;</p>
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		<title>Zooming away from Zoom-Zoom</title>
		<link>http://acepraeshugyosha.wordpress.com/2008/09/11/zooming-away-from-zoom-zoom/</link>
		<comments>http://acepraeshugyosha.wordpress.com/2008/09/11/zooming-away-from-zoom-zoom/#comments</comments>
		<pubDate>Thu, 11 Sep 2008 07:04:59 +0000</pubDate>
		<dc:creator>acepraeshugyosha</dc:creator>
				<category><![CDATA[Rambling]]></category>

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		<description><![CDATA[I enjoy driving my Mazda 3.  Even after I&#8217;ve driven it for close to 3 years, the excitement never seem to leave me.  I guess that&#8217;s what the Mazda designers and engineers mean when they promise to provide the &#8216;Zoom Zoom Experience&#8217; through their cars. The only complaint, however, is that Mazda cars are fuel-guzzlers [...]<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=acepraeshugyosha.wordpress.com&amp;blog=4773631&amp;post=10&amp;subd=acepraeshugyosha&amp;ref=&amp;feed=1" width="1" height="1" />]]></description>
			<content:encoded><![CDATA[<p>I enjoy driving my Mazda 3.  Even after I&#8217;ve driven it for close to 3 years, the excitement never seem to leave me.  I guess that&#8217;s what the Mazda designers and engineers mean when they promise to provide the &#8216;Zoom Zoom Experience&#8217; through their cars.</p>
<p>The only complaint, however, is that Mazda cars are fuel-guzzlers amongst the Japanese cars, and I can attest to that.  But there are many factors that one need to consider:</p>
<p>1. Mazda cars are designed to be sporty, and thus generally attact drivers who love to drive sportily.  One can imagine the kind of fuel consumption these drivers chalk up.</p>
<p>2. Because they are designed to be sporty, they are also designed to be safe.  Mazda cars are actually heavy in comparison to other cars in their respective classes.  The additional weight definitely adds up to the FC.  As for my Mazda 3, I reinforced it with all possible undercarriage strutbars, added a sun-roof and dressed my car with some 18&#8243; rims. The result: a damn heavy but sexy car.</p>
<p>So, in an attempt to improve FC, I added certain modifications to my car &#8211; kinda silly if you ask me, but hey, I was young and naive and this is my first car.  I added the Broquet fuel charger, an air charger and voltage stabiliser, and I drive smart i.e. I don&#8217;t accelerate like crazy and anticipate traffic.</p>
<p>With these, I manage to do between 11-12km/l of petrol. Not bad for a car with a manufacturer&#8217;s estimate of between 9-10km/l.</p>
<p>But times are tough, an I&#8217;m more aware of the environmental consequences of our actions.  Singapore has seen the fastest rise in the number of cars on the road, and this is starting to cause congestion in many places, prompting the transport authorities to implement taxes to drivers in the form of Electronic Road Pricing (ERP).</p>
<p>So, in a bid to do my part, I&#8217;m thinking of switching a hybrid car &#8211; one that runs on both petrol and battery.  Of course, there&#8217;s the CNG, but it&#8217;s not that much cheaper ($1.50/kg of CNG vs $1.95/l of petrol), it eats up boot space and there are not many CNG pumps in Singapore.</p>
<p>So, I&#8217;m contemplating of getting either the Toyota Prius or the Honda Civic.  It hurts me inside to know that neither of these cars have the power, sportiness and handling of my Mazda (Mazda, by the way, has the best handling of any car make, ever, which is why it is such a fun ride).  In fact, a person buys car for several purposes: a show of status (luxury cars), a show of youth and sportiness (sports car and the other trendy-looking cars).  It&#8217;s not easy to find a cheap car that is both sporthy and green.  In fact, the reality is that a hybrid car can never be as bold or as fast as a 100% petrol-run car.</p>
<p>It&#8217;s so easy to fall to temptation.  Do I need a sporty car?  Singapore is so small and the speed limits are so stiffling that if one were to own a Ferrari, one would be frustrated most of the time.  I don&#8217;t need it for glamour or show of status, because that&#8217;s not my intention in the first place.  When I go out, wearing my jeans and T-shirt, no one even knows my occupation.  I look like a freshie in university.</p>
<p>All I do is drive my car to work and back, and once in a while, use it to go out with my friends.</p>
<p>It is hard to resist temptation, but once one can find a cause and purpose, the decision would be simple.  My cause would be to protect the environment in ways that I am able to controle.  Like switching off the clinic lights and computer screens when I&#8217;m off duty, turn down the air-conditioning, and to drive a hybrid car (cos I really enjoy the drive &#8211; it&#8217;s my silent moment MY TIME).</p>
<p>So, I have my cause&#8230; zooming away from zoom-zoom, while still hard, is a tad easier now&#8230;</p>
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