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OPINION
THE LONG INTERVIEW | CHANGE-MAKERS A man given to startling pronouncements, Alexandra Health group chief executive Liak Teng Lit gives Susan Long the lowdown on what ails the health-care system today: over-treatment, over-specialisation and over-generous subsidies.
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Mr Liak Teng Lit, 59, runs 25km a week, and has finished eight marathons. He says that when it is his turn to die, he would like it to be during a race while he is healthy and fit. ST PHOTO: RAJ NADARAJAN
78-YEAR-OLD nursing home resident was wheeled into hospital in a comatose state. He suffered from dementia, had one leg amputated and the other was gangrenous due to poorly controlled diabetes. He had no known family members. Mr Liak Teng Lit, then chief executive of Alexandra Hospital, was discussing with over 200 doctors and health-care professionals whether they should proceed to amputate his remaining leg. Two-thirds voted yes. Doctors, after all, are under oath to save lives. When he asked how many would want to be operated on if they were the patient, two said yes. The rest said no. It was a moment of epiphany, he says. We discussed why we do things for our patients that we wouldnt want done to ourselves. The answer that came back was, I dont know what he wants, so I do my best. My best is to prolong his life. But if we were the patient, we wouldnt want those kinds of extra days. The human body is designed to die eventually, he says. Fighting death hooked up to ventilators and fed through intravenous tubes results in the patient having unnecessary procedures which do nothing but extend pain. But its easier to overdo than to underdo, because if you overdo, nobody is going to scold you. In April, the straight-talking 59-year-old was appointed group chief executive of Alexandra Health, a health-care cluster that serves northern Singapore. Sitting in his office in the award-winning Khoo Teck Puat Hospital (KTPH), whose construction he oversaw, he muses that this is the age of overdoing, especially for the well-heeled desperate to buy more time with loved ones. The father of three children aged 23, 22 and 14 has given strict instructions to his wife, a pharmacist turned housewife, that the day he can no longer recognise his family is when he does not want any form of artificial intervention such as tube feeding or even oral antibiotics. When the end comes, it should come, he says, adding that many doctors and nurses choose this path because they, more than anyone else, understand the limits of medicine and have seen enough. When his mother died at 78 of advanced colon cancer in 1993 and his sister at 56 of late-stage liver cancer in 2008, both opted
for palliative care rather than further treatment. They had a good death, surrounded by loved ones. There was no unnecessary pain and we had a little celebration of their lives, he recounts. The runner, who clocks 25km a week and has finished eight marathons his first at age 51 says his preferred way is to die during a race. Thats exactly the way I want to go, being healthy and fit, says the man known for making jaw-dropping statements with a deadpan face.
The problem with hospitals here today is they are a one-size-fits-all model trying to do fast medicine everywhere, but doing nothing well. Singaporeans rush to the hospital with minor ailments, routine vaccinations or check-ups that can be done by GPs, dieticians and nurses. Alexandra Health is trying to do it differently by integrating its work, facilities and staff fully with the community. He wants the health cluster to offer head-to-toe lifelong anticipatory health care of the whole person, with a team caring for the whole person, not each doctor caring for one body part. It has six nurses who run up to the neighbouring blocks to check on frail people and change their tubes. It is also exploring virtual consultations for bedridden patients who would otherwise need an ambulance to be brought to hospital to see a doctor. Bank call centres are his prototype, as half of all banking transactions are now handled by phone. His target for health care: 30 to 40 per cent. He is also planning the upcoming Yishun Community Hospital (to be ready in 2015), where an elderly person, after staying at KTPH for three days for a knee replacement operation, can move into for two weeks to get used to new medicine and a new routine. In the works is also an off-site specialists centre for outpatient and day surgery at Admiralty MRT station by 2016. But his end goal is really to enable someone who is bedridden to stay home until the end, minimising visits to the hospital. He hopes that slightly younger neighbours in their 60s, who are still fairly fit, will step up by helping to prepare an extra meal and sponge bathe them for a monthly fee of say, $500.
Follow the British National Health Service? That may mean that the Government has to increase the goods and services tax to, say, 20 per cent to cover the cost of these additional beds, he says, adding that Singapores 3M framework Medisave, MediShield and Medifund is sound. As diseases are increasingly diagnosed at the molecular level with more expensive drugs, costs will shoot through the roof. His fear for Singaporeans today is that they clamour for their rights but disown their responsibilities. In cyberspace, there are howling monkeys who scream, shout and demoralise others.
My worry is that everybody is screaming about his rights as a citizen to get subsidies, but he doesnt feel he has a responsibility to contribute or pay his taxes. They have the right to treatment but dont have a responsibility to take care of their health, he says.
(NUS) to study pharmacy, his second choice. He topped it off with an MBA from NUS and a masters in pharmaceutical sciences from the University of Aston in Britain. The man whose mantra is learn from everyone, follow no one, look for patterns, work like hell was involved in restructuring major hospitals, including the National University Hospital, KK Womens and Childrens Hospital and Singapore General Hospital. He was chief executive variously of Alexandra Hospital from 2000 to 2010, Changi General Hospital from 1997 to 2000 and Toa Payoh Hospital from 1992 to 1996. From 2010 till earlier this year, he was chief executive of KTPH. He ruffled feathers two years ago when he said excess weight might weigh down a health-care workers career prospects. Around KTPH, signs abound encouraging people to take the stairs. Healthy options in the hospital canteen, such as brown rice, are priced cheaper. He methodically picks up every piece of rubbish in sight, disapproves of bicycles not parked in assigned bays and clears tables of cups left behind. Change, he believes, starts with himself, then getting the right people on the bus with him, then slowly inching towards perfection. He has set bold benchmarks for his hospitals: to be as verdant as the Singapore Botanic Gardens, to orientate guests as well as Ritz-Carlton Millenia hotels, to operate with Ikeas efficient simplicity and to turn beds around as fast as Singapore Airlines does cabins. The man who subscribes to Buddhist philosophy has this advice for aspiring change makers: Dont expect any support from higher-ups or people around you. All laws, all rules, all organisations, all systems and processes exist to maintain the status quo. His goal is to plant a million trees and do his part to make Singapore a city in a tropical rainforest. He reckons he has so far planted or commissioned the planting of over 300,000 trees about a third of his target through all the projects he has undertaken to bring healing nature everywhere. He says straight-faced that his hero is the dung beetle, which feeds on faeces. They walk the ground, burrow underground, clean up the environment, recycle nutrients and improve soil aeration. Most of all, they solve problems others leave behind. suelong@sph.com.sg