Professor Tan Eng Chye, President, NUS
Professor Chong Yap Seng, Dean, Yong Loo Lin School of Medicine
Graduating students from the Class of 2019,
Ladies and gentlemen,
Introduction
1. Thank you very much for having me tonight. I am happy to join you tonight to congratulate the graduands from the Class of 2019. Some of them cannot be here tonight because they are already on duty and on calls, but please join me in giving them a big round of applause.
2. Let me also join the School to recognise the contributions of Mr Tan Jiak Kim and other pioneers, who played this decisive role to raise funds and help realise the vision of a medical school in Singapore. On behalf of the Ministry of Education, I would also like to express our sincere gratitude to Mr Tan, and I think some of his descendants are here tonight, for this significant contribution to Singapore's education landscape. Thank you.
3. For more than a century since, the graduates of the School have provided an essential service to Singaporeans. Through their standards of care and ground-breaking research, they have also helped put Singapore on the world map for medicine and healthcare.
4. As a well-regarded medical school, admissions to the Yong Loo Lin School of Medicine today are very competitive, with around 2000 applicants for the 280 places this year. The school had to go way beyond academic achievements to assess the applicants, and they are all very well-qualified. But they have to take into account their activities outside of study, contributions to the community, their passion and their character. The school is therefore an experienced practitioner of aptitude-based admission system, something which I am encouraging all Autonomous Universities to embrace.
5. Hence, at Yong Loo Lin School of Medicine, there is always an avenue to recognise those with exceptional talent and achievements, regardless of their backgrounds. And I know that the school will be taking in your first ITE graduate this year, Mr Nicholas Chan. Through an enlightened admissions approach, all pathways are made possible.
Weakening Public Trust
6. As our newest graduates commence your careers, you are not just taking up a job with an employer, you are joining public institutions in the public healthcare system, which is a national institution. For a national institution to be effective, it needs leadership and talent, effective organisation, and above all, it needs public trust – the most important ingredient. But trust should not be taken for granted, and this is the topic I would like to talk about today.
7. Many of you may share this experience that I had with my first car. For me, a Suzuki Swift, bought over 20 years ago. The first time it had a problem, I sent it to a mechanic who told me there were several things to rectify, and quoted me a price to rectify them. It was quite a bit of money, and I was none the wiser as to whether that was a fair price.
8. I consulted a friend from NS who was a mechanic in my camp. He had some wise words: ‘Never trust the opinion of just one mechanic, always ask for a second opinion.’ In the end I decided not to go through the trouble of asking for a second opinion, and got the car repaired. Till today, I do not know if I paid a good price.
9. So I had a trust problem with my mechanic. Fortunately, I have now found a good car repair shop that I trust. I am sure it makes money off me, but I am happy, because I trust the shop.
10. That problem is evident today all over the world. Public trust towards institutions, generally, I think, is weakening. The medical profession, the education system, the mainstream media or even Governments – nobody is spared.
11. In some countries, patients will sue doctors, and maybe vice versa. Dr Wong Chiang Yin wrote in the Straits Times recently, and he said that if doctors start seeing every patient as a potential plaintiff, that would be when doctors start to practise “assurance and avoidance defensive medicine”. This means ordering more tests and procedures or prescribing more medicine than required for assurance, or rule out higher-risk procedures on patients even though it may be the correct treatment for purposes of avoidance.
12. In the case of government services, say we have a frontline public officer who is attending to a member of the public over the counter with a request. If the officer suspects that the member of the public is secretly recording the conversation and if he is not happy with the answer, he would upload to social media and create a fuss, then there is no trust, and service cannot possibly be good. The public officer will ensure he sticks strictly to the rules, the procedures and the script, because that is publicly most defensible. So forget about the exercising of judgement and flexibility to cater to exceptional circumstances.
13. When there is no open and honest communication, and trust is weakened, the system and the institution as we know it can no longer serve its recipients well. In fact, you will start to get perverse behaviour, like defensive medicine.
What Are The Causes?
14. So what is causing this wave of weakening of trust all over the world towards institutions? Some suggest it is due to the asymmetry of information. This is economic jargon, to describe a situation when the service provider knows much more than the buyer. So the buyer is none the wiser when the service provider decides to fleece the customer.
15. But it is an explanation overly illustrated using car mechanics. In fact, it is a feature in many professional services, certainly in healthcare, and also in education. But this cannot be the reason for the weakening of trust, because surely we want to be served by someone who knows more than us. I would be worried if my doctor knows about medicine only as much as I do.
16. Others explained that the weakening of trust is perhaps caused by customers knowing more, because they can Google. As they say, a little bit of knowledge is a scary thing.
17. I don’t quite buy that reason either. Indeed, with greater access to information and knowledge, patients can now question the doctor’s advice, seek further clarifications on the treatment proposed, and even present alternate options that they have read about. The tables have somewhat been turned.
18. It is the same in education, where every parent is also an expert in education, as they are the first educators of their children. They will scrutinise the school’s curriculum, check the markings of teachers, and offer alternate pedagogical methods. As the Minister and chief policy maker of MOE, I receive many policy suggestions from parents, such as pushing back the starting time in schools so that students can sleep later, re-designing the school canteen diet, and revamping the Primary One admission process, which is one of the most common proposals. I get all kinds of suggestions all the time, some of which are very well-considered.
19. And I think it is not a bad thing that the people we are serving are getting more educated, informed and questioning, and taking an interest in our work. We should not mistake this as a lack of trust in our profession or our judgment. I think what it means is that what we are doing matters a lot to the public, and they want to know more about what we are doing.
20. I can’t really pinpoint the reason for the current trend of eroding trust all over the world. But what I do know is that as a result of digital technology, the way we consume information, distribute information, interact with each other, conduct business with authorities and institutions – they are all undergoing profound changes. And this must over time change the texture of human relationships in society and affects trust.
21. To give just one illustration, we know that through the mass media, bad news often gets exaggerated and travel much faster than good news. With digital technology, that process has gone into overdrive. Imagine if we all read a piece of negative news about a profession every day, over time, your trust in it will be eroded, even though nothing about the profession has changed. Remember, water that drips on a hard rock, over time, will create a hole.
Preserving Trust
22. So how do we avoid sliding into the unhealthy conditions of mistrust? We can hope that the public continues to value our services and respect our professionalism, will be discerning in the news they consume, and handle the information they receive properly. But that is outside of our control. I say, as professionals and public institutions, we need to do our utmost to earn and retain public trust. There are a few ways to do this. They are fairly fundamental principles, but are nevertheless worth reminding ourselves.
23. First, always be competent and safeguard the role of expertise in our society. We must ensure institutions that impart professional knowledge, whether it is the Yong Loo Lin School of Medicine, the Lee Kong Chian School of Medicine, the National Institute of Education or MOE, or the SAFTI Military Institute, we maintain high standards of teaching and training. Within each profession, the seniors must mentor, coach and guide the juniors, as an integral part of their professional roles.
24. Second, uphold our code of conduct. For the medical community, the Singapore Medical Council or SMC sets out guidelines for practice such as the ethical code and regulates the conduct of doctors. But a good code of conduct needs to work both ways, protecting the client as much as the service provider, in this case the doctors, by setting out common standards and expectations about the practice.
25. It is the same for public officers. They are required to serve the public respectfully and politely, but at the same time, government agencies must protect public officers from abuse by the public and stand up for public officers. So I can understand why the heavy penalties meted out by the SMC in a few recent cases, caused much unease within the medical community. Because they created uncertainty in the doctor-patient relationship and raised questions about whether SMC’s approaches and processes need updating, and indeed the Ministry of Health has moved to do so.
26. Third, as a professional community, always contribute back to society, and have a heart for those who are less fortunate. In this regard, the medical profession has been very active. I have met many nurses who are contributing their time and effort in the community, reaching out to disadvantaged families, supporting the elderly sick. Every year, many senior members of this community make donations to our local medical schools, to help our students from lower income families.
27. Finally, above all, stay true to the ethos to serve. We place the people we serve – be it patients, students or citizens - at the centre of all that we do. For medical professionals, this comes back to your pledge to make the health of the patient your first consideration and to respect the dignity of patients under your care. The day we waver from this, we will no longer be fit to serve.
Conclusion
28. Today, the medical profession in Singapore is still highly respected, trusted and sought after by many talented and aspiring young. Every new batch of graduates has to carry this torch forward, and I am sure this current batch will continue to do so.
29. Like you, I also belong to the newest batch of my profession. People call us the 4G Ministers. And just like you, we need to be competent in running our organisations and uphold a high standard code of conduct. We need to ensure that policies serve the people and the society for the long term, even if this is not evident in the short term. Above all, we need to stay true to the ethos to serve as well. We have the privilege of holding positions of trust, and we must do our utmost to safeguard it.
30. As the Class of 2019, I urge you to serve your patients with compassion and integrity, and to go above and beyond your clinical and nursing obligations, to use the skills, knowledge and expertise that you have gained, as you formally join the healthcare fraternity. I wish you all the best as you begin the next chapter of your life.
31. Thank you.