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Doctors' Fees



I have received several e-mail about Dr Susan Lim, the surgeon who overcharged her patient.

It is extremely disheartening to learn about Susan Lim's greed. Unfortunately it does not appear to be confined to her alone. Many Singapore doctors feel that it is justifiable to charge their patients $450,000 per day. I am disappointed with them. Let me explain why.

There are several aspects to consider when approaching the question of medical charges in a free economy. On the one hand, some might regard medicine as a business, and therefore it can charge whatever the market can bear.

For example, Apple manufactures their iPods in China at a fraction of the cost of what they are selling for. The same with many branded goods. Business people are proud that they can make a profit of several hundred percent.

But can medicine be considered a business? The answer is rather complex. If you do not buy an iPod or a pair of branded shoes, it does not matter. They are not absolute essentials. However, clinical medicine might be dealing with critical matters, such as life and death issues. Doctors have an obligation to attend to patients who seek their help. Therefore, medical charges should not be beyond the reach of all patients, both rich and poor.

You might argue that if a rich billionaire can afford to pay more, why not charge more? The doctor may even be regarded as a Robin Hood, "robbing" the rich, and giving (hopefully)  to the poor. However, there is a problem with this outlook, as illustrated by the Susan Lim case.

People's salaries have evolved from hundreds of years of history. It is a social contract between society and the individual. In a democratic capitalist society, wages depend on many factors, including the scarcity of that particular worker's skills, and how much revenue that person is generating. Top bankers, businessmen, entertainers, sportsmen, lawyers, earn multi-million dollars. The public have accepted this. There is one proviso. When bankers were paid millions of dollars in bonuses at a time when their bank lost billions of dollars, there was a public outcry.

However, there are several professions that the public treats differently. These include service occupations and charities. Doctors, nurses, teachers, civil servants, social workers, are among the occupations that are expected to be selfless, self-sacrificial, altruistic. Because of this, they are bestowed special trust and respect. People opting for these professions are expected to be honest, to have absolute integrity, and not to exploit their position in society.

There is a sense of fairness at play here. Society supports these professions and wants to show its appreciation. Hence the earnings of these professions are adequate, perhaps even a little above average, but certainly not excessive. In a free market, doctors may charge slightly above the mean for their services, but they are expected to exert restraint and fairplay.

This trust and respect is betrayed when a doctor overcharges. In the case of Susan Lim, the public is outraged by her excessive greed.

It takes a lifetime to build up one's reputation, but it takes only a fraction of that time to lose one's reputation. Unfortunately, the loss of respect is not confined to just the one doctor. The entire medical profession becomes tainted.

The Singapore Medical Council must take action that would restore the public's faith in the profession.

Kenneth Lyen
27 Feb 2011