25 Apr 2013


One year ago, a girl described her aspiration to serve the poor at our admission interview. I asked, “In the current public hospital system, patients have to line up for investigations and treatment. For example, a cancer patient may have to wait several weeks before surgery can be performed. Now, if she agrees to pay for the service as a private case, the surgery can be done on the next day. Do you find this acceptable?”

“No,” the girl replied promptly, “all people should have equal access to medical care. Allowing rich people to jump the queue is unfair and is a discrimination against poor people.”

“Are you against private medical service in general? If the same patient enjoys immediate surgery at a luxurious private hospital, is it unfair?” I pursued. The girl appeared less confident. “I still feel it not right.”

After the interview, my co-interviewer exclaimed, “Communism!”

I did not have any standpoint when I asked the question. Some are proud to be the doctors of the richest men in town, while others take pride in serving the public. I thought it was just a matter of choice. It was not until the hospital raised the private consultation fees that I gave the matter another thought.

Our administrators would tell you that the private service at public hospitals serves a noble mission – to earn money to support other public services. Besides, the two systems are separate and would not interfere with each other. Both arguments are flawed. First, the purpose of public hospitals is to provide affordable medical service to the public, not earning money. If resource is at stake, we should seek support from the government and cut unnecessary wastages. At the same time, patients who can afford private service may be encouraged to do so. We do not need to provide private service ourselves.

Second, we are the same doctors. When we are seeing private patients, we cannot be seeing public patients at the same time. Whenever some of us perform endoscopies for private patients, we occupy the rooms and our colleagues can just stay idly in the waiting area. It is difficult to conceive how public service would not be affected.

Of course, our applicant did not know the inside story. Her argument therefore centered on equality. Is equality a sound argument against private medical practice?

18 Apr 2013

April Fools

“Do you know the hospital has raised the consultation fee for private patients substantially this month?” AC called me last week. “I told the new patients the old rates. Should I call them again?”

To be honest, I received an e-mail about this some time ago but chose to ignore it. The new rates were so ridiculous that I did not know what to do. The e-mail explained that the rates had not been adjusted for a decade but neglected the fact that the original fees were already several times higher than the market rate. I just did not realize All Fools’ Day came so soon.

My recent reading is Justice: What’s the Right Thing to Do? by Michael Sandel. The book began with the story of Hurricane Charley in 2004. In the wake of the disaster, there was widespread price gouging in Florida. A contractor charged $23,000 to remove trees from a rooftop. People had to pay a fortune to stay in motels. Oil and food were sold at unbelievable prices.

Florida has a law against gouging. Not surprisingly, the Florida people filed a number of lawsuits afterwards. Some people disagreed. Thomas Sowell explained that there is no such thing as a fair price. In a free market, price would naturally respond to market conditions. During a disaster, it is better to raise the price. First, this limits wasteful use of scarce resources. Second, suppliers would then be attracted to provide goods and services. It is not unjust but reflects the value buyers and sellers mutually agreed upon. To go one step further, Jeff Jacoby argued that suppressing the price in such a situation would actually slow down Florida’s recovery.

In response, Attorney General Crist stated that such arguments do not apply in times of emergency. Buyers under duress have no freedom. Their purchases of necessities like safe lodging are forced.

Of course, medical consultations are different from services during a natural disaster. They however still have a lot in common. Let’s apply the theories of justice and ponder on two questions first. Should public doctors provide private service? Should doctors be allowed to charge whatever they want?

11 Apr 2013


Last Friday, LH helped us at the clinic as a volunteer. LH is three years more senior than me and was amongst the first in our team to join the private market. That is to say something. For a long time the first generation trainees never imagined life outside the team.

As LH described the life of a private gastroenterologist, I could not help thinking of a little story from Life of Pi.

‘We had a mouse that lived for several weeks with the vipers. While other mice dropped in the terrarium disappeared within two days, this little brown Methuselah built itself a nest, stored the grains we gave it in various hideaways and scampered about in plain sight of the snakes. We were amazed. We put up a sign to bring the mouse to the public’s attention. It finally met its end in a curious way: a young viper bit it. Was the viper unaware of the mouse’s special status? Unsocialized to it, perhaps? Whatever the case, the mouse was bitten by a young viper but devoured – and immediately – by an adult. If there was a spell, it was broken by the young one.’

4 Apr 2013


The natural result of becoming an organist is that I have to attend the church regularly. Over the Easter holidays, I had to go there three times. This has never happened since my graduation. But as Rick Warren mentioned in The Purpose Driven Life, to love the Lord your God with all your strength means it takes effort and energy. You cannot just ask for the convenient way.

Many people think that pianists should automatically be able to play organs. This is not true. For example, you cannot control the loudness by how hard you hit the keys. This creates some difficulty for me who love to exert subtle control within a phrase. For that matter, it also means that I cannot bring out the right or left hand melodies at ease.

The other problem is I cannot sustain a note using the pedal. Handled improperly, a song can be full of unnatural hiccups. When I first played organ, I practised with the fugues by J.S. Bach. Soon, I found it unhelpful. Fugues are supposed to be played without pedal anyway. Therefore, I turned to the sonatas by Mozart. In fact, Mozart’s earlier works were written before the invention of pedals. In a letter from Mozart to his father, he vividly described the wonder of pedals. In any case, I can now play all his sonatas reasonably well without pedal. Through the process, I also discovered many lines that I was blinded to before.

P.S. Mozart has actually written a number of unfinished fugues. This was because his wife was very fond of Bach’s fugues and made him write a few for her entertainment. Mozart tried but was dissatisfied with the unfamiliar patterns.

P.P.S. We met our classmates recently. They talked about MY, who unfortunately suffered from a serious complication. When we were at our final year of study, MY once tried to play Chopin’s nocturne but found it too difficult. I offered to play the left hand part for her. That was probably the best nocturne performance in my life. May she recover well.