June 25, 2017

Tags Posts tagged with "medical"


by George Khoo

I saw the signs a couple of months before my daughter’s wedding. The year running up to this point had been rough. I was feeling upset, tired, irritable and angry almost every day. I teared up easily and was constantly thinking negative thoughts, sometimes even suicidal ones.

Even though I was so tired most days, I wasn’t able to sleep properly, often waking up in the wee hours of the morning. How I felt added to my fatigue, frustration, hopelessness, guilt and feelings of worthlessness.

While the truth that I was clinically depressed started to sink in, I was probably still in denial and hoped that with time, rest and exercise, things would improve. However, it just got worse and the low moods and negative thoughts persisted.

Part of the reason for not seeking help early was because I’m from the medical profession. I felt that admitting that I needed help would not reflect well on me – a healthcare provider who’s not even able to care for himself.


How did it get this bad?

It wasn’t the volume of work that affected me most but the issues in my relationships. I have always tried to live peacefully with my fellow man and it’s not in my nature to confront others. However, the leadership roles I’ve taken up at work and in my church have increasingly put me into situations that require confrontation.

I had patients that year that I expected would be grateful to me but turned around to question me on the wisdom of the recommendations I had made with their best interests at heart. I had a colleague who was pushing me to pursue something I was not comfortable with. And I had to confront people who had made wrong choices and required disciplinary action. Meanwhile, in church, a man told me to my face that he wanted me to step down as a church leader.

The worst was when a leader at work, unhappy with a policy I was trying to revise, accused me of being more interested in systems and policies than in caring for patients. I had spent sleepless nights worrying for my patients and trying to get them good healthcare and while what the leader said was absurd, it really hurt to hear him say that to me.

All of this played into my feelings of worthlessness and frustration, causing me to feel even more irritable and upset than I already was.


An unusual sense of loss

At some point, however, I realised that these were not the only causes for what I was feeling. It dawned on me that a big factor was the prospect of ‘losing’ my precious daughter once she gets married. That year, we must have attended close to 10 other weddings and I dreaded going to them because they just reminded me that soon, I was to give away my own daughter. Each wedding became more and more difficult to attend and the worst was the one two weeks before her wedding. I teared throughout the wedding thinking of what it was going to be like on that day!

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I was unable to make sense of how depressed this made me feel until I read Unmasking Male Depression by Archibald D. Hart:

“Then there was the time when my first daughter was going to be married. I found myself quite depressed a few months before the wedding. Finally, it dawned on me that my little girl was saying goodbye to me in favour of a young man who was not part of me. Like it or not, being excited for my daughter was not enough to overcome my sense of sadness. I was facing a loss that could never be replaced. There were those who said to me, “You’re not losing a daughter but gaining a son-in-law.” What a ridiculous idea! What I was losing could not be counterbalanced by what I was gaining. Every father of a daughter knows that a son-in-law does not equal a daughter!”

Coming across that passage was like hitting the jackpot (not that I play). Finally, someone understood how I was feeling – he had been through the same thing and knew how I felt.


Getting help

I finally plucked up the courage to make an appointment with a psychiatrist to confirm my own suspicion. I needed to know for sure, to be fair to my family and my loved ones. In any case, I had reached a point where not much else mattered and I wasn’t bothered about the stigma associated with taking anti-depressants 

I had reached a point where not much else mattered and I wasn’t bothered about the stigma associated with taking anti-depressants

I was put on Lexapro (escitalopram) and during my review, three and half months after my first appointment, my psychiatrist doubled my dosage. I was definitely feeling better in terms of having less frequent thoughts of hopelessness and a stop to the suicidal thoughts but I was not “walking on clouds”. About a week later, I distinctly remember waking up one morning and thinking: “Oh, this is what it feels to be normal?” That morning, after many months of feeling down, moody and negative, I felt that burden lift. My medication was working well.

The other thing that helped me greatly was reading the Bible and other Christian literature on depression and burnout. I found them to be great in creating self-awareness and for self-therapy.


“I believe that I shall look upon the goodness of the Lord in the land of the living! Wait for the Lord; be strong, and let your heart take courage; wait for the Lord!”Psalm 27:13-14

“Despite being a dedicated gospel-hearted Christian who preached grace, the truth is that I was dangerously close to living a gospel of works, not grace.” – Christopher Ash, Zeal without Burnout

“The surprising truth is that the person who pauses long enough to refresh his soul along the way actually becomes more alert, more alive, more efficient.” – W. Phillip Keller, Strength of Soul


The other main factor on my road to recovery was the tremendous support given to me by my beloved wife and family. At the end of our family holiday, six weeks before my daughter’s wedding, I decided to be open with them at the airport while waiting for our flight back to Singapore. I am thankful that they took it very well and were very encouraging.

My wife, who knew my struggles all throughout, was a pillar of strength when my whole world was crumbling emotionally. She is not only my best confidante and my best friend, she also makes me laugh and reminded me to rest. She was ever patient with me when I was negative and moody and even scratches my back to help me sleep! God gave her the strength and grace to put up with me.

It’s been a two and a half year journey and while my psychiatrist has encouraged me to try weaning off the Lexapro, I realise that as long as I am in my current role, in church and at work, it would not be possible. I have tried weaning it off but have had to go back on my medication rather quickly. Nonetheless, my dosage has halved and my recovery has been steady.

Having been through the worst periods has helped me to be more disciplined about taking regular breaks. Now, I take a week off every three to four months and am intentional about observing the weekly Sabbath as a time of rest from work. As the writer Christopher Ash puts it in Zeal without Burnout, “God needs no day off. But I am not God, and I do.”



I have chosen to be open about the fact that I am still on anti-depressants because there is a need to remove the stigma associated with it. In Singapore and in this part of the world, to be on anti-depressants is still very much taboo. Thankfully, I work in a Christian organization that fully understands and supports my stand. However, other employers may not be as understanding and that is probably one of the main reasons why people do not speak up – the fear of losing their jobs or not getting one should they be honest.

While it is probably too idealistic to expect no discrimination at all, I hope that we can help employers be open to accepting applicants with a history of mental illness but are stable on medication. They should be at least considered in the same way as those with other chronic illnesses such as hypertension or diabetes. As long as they are capable of performing the tasks and do not pose a danger to themselves or others, they should be given equal opportunities.

“The lines have fallen for me in pleasant places; 
indeed, I have a beautiful inheritance. – Psalm 16:6


Dr George Khoo is a general practitioner in his late 50’s and serves as the Medical Advisor for a Christian organisation. George is married to Mabel and has two grown up children, both happily married. George and Mabel have a newborn grandchild and are expecting a second within the next few weeks.


Featured image by Sean Chong.

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Photo from TMG File
The C class ward at Alexandra Hospital.

by Elias Wee

PUBLIC feedback for a mid-priced insurance plan has been heard. The new Standard B1 Integrated Shield Plan (IP) was announced this week, after recommendations were made to the MediShield Life Review Committee in 2014. Five private insurers – AIA, Aviva, Great Eastern, Prudential, and NTUC Income – will start offering the new plan from May this year.

If you’re currently only on MediShield Life, or on one of the IPs, you may be thinking of switching to this new Standard B1 IP, whose coverage and premium costs fall somewhere between the two types of policies.

But is the new plan right for you? Here are the 5Cs about that new B1 plan you can ask your insurance provider.



1. I hear private hospitals are more comfortable. Does this new plan cover private hospital stays?

No. Public hospital wards go by Class A, B1, B2, or C. Upgrading from MediShield Life – which covers Class B2/C wards – will only bump you up to B1. Still public. If you currently have an IP and cannot do without the comforts of private hospitals, don’t downsize.

2. What material comforts can I expect from making the switch?

Air-conditioning, television, fewer beds (four, instead of six) – these are the material benefits of upgrading from MediShield Life to the new plan. Even if you’re currently covered by an IP, you may consider a switch, especially if you don’t view private hospitals or Class A wards as necessary. At least B1 has air-conditioning.



3. If I were to switch, any changes to my coverage?

All plans cover large hospital bills, surgical procedures, and selected outpatient treatments, such as kidney dialysis and chemotherapy. However, the new Standard B1 IP, like MediShield Life, does not cover pre- and post-hospital treatment. For a more thorough understanding of your coverage, check with your insurance provider.

4. Does age affect my coverage?

MediShield Life and the Standard B1 IP do not have age restrictions; they cover you for life – so whether you’re downgrading or upgrading to the new plan, your age won’t matter.

5. How will making the switch affect coverage of my pre-existing conditions?

MediShield Life covers all pre-existing conditions, but upgrading can be problematic. According to MOH, private insurers providing Standard B1 IPs may “assess, approve with or without exclusions, or reject applications”. And downsizing by switching insurers might mean that pre-existing conditions will not be covered after being re-evaluated. You can, however, maintain full coverage by downsizing through your current insurer, if it already covers you fully.



6. So what’s all this going to cost me?

MediShield Life, Standard B1 IP, and current IPs generally charge different premiums in this increasing order. Take note: the five private insurers also charge different premiums for the Standard B1 IP. For the first two years, these premiums will not change. After that, insurers may raise premiums differently. Because insurance is a longterm plan, be sure to check with your insurance provider to get an estimate for your premiums after the first two years if you’re thinking of making a switch.

7. What are some ways I can pay for these premiums?

Whether upgrading or downsizing to the Standard B1 IP,  you may fully pay for premiums using Medisave (at least until the age of 75).



8. Will there be any changes to limits on my claims?

Yes. When you upgrade, claim limits increase. MediShield Life claim limits are $700 a day in B2/C, and $1,200 a day in Intensive Care Unit (ICU); Standard B1 IP claim limits are $1,700 a day in B1, and $2,900 a day in ICU. Claim limits of current IPs vary with each scheme. Check with your insurance providers about the claim limits for your particular IP.

9. Can you give me another specific example about the differences in claims?

Take kidney dialysis. The amount claimable for it more than doubles when upgrading from MediShield Life to Standard B1 IP: $1,000 per month to $2,750 per month. But downsizing from current IPs may, depending on your plan, decrease the amount claimable, because some current IPs cover whatever the cost of kidney dialysis “as per charged”.



10. Who will be treating me?

Upgrading to the new Standard B1 IP will allow you to choose your doctor; MediShield Life does not. Downsizing from current IPs will still allow you to choose your own doctor.



Medical Insurance



Featured image from TMG file. 

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Citizen timepiece with clock hands pointing at 8:30
Citizen timepiece shows 8:30

It’s July 17 and wish our Muslim readers Selamat Hari Raya Adilfitri. We hope you are opening your homes to, ah, non-Muslim friends to sample the Malay delicacies that you have been cooking up over the month of Ramadan? Okay, that was a bad attempt at an invitation… The various news reports over the past weeks, of Muslims breaking fast together, not just among family members, have been heart-warming. May that same spirit deepen within the community, and spread beyond.

Back to business.

It’s all about drugs. Of the medical kind. The laboratories here have been churning out all sorts of medical discoveries that we’re not surprised if your eyes glazed over when you read about yet another “finding”. Little developments on how a virus works, or the properties of some germ, or the efficacy of yet another vaccine can’t quite beat a cure for cancer, right? Except that Singapore might be on its way to finding, ahem, a cure for cancer, according to The Straits Times.

The Agency for Science, Technology and Research (A*Star), and Duke-NUS Graduate Medical School is testing an anti-cancer pill on humans, and that’s significant because this means it has passed through several stages of study before a green light is given for human experiments. Singapore’s boast: “It is the first publicly-funded drug candidate discovered and developed in Singapore to advance into first-in-human trials.” Note though that it will take 10 to 15 years for a drug to go from conception to market.

Let’s hope this is a real breakthrough and people will be kept informed of the progress. Because while scientists are always keen to report on new findings and developments that cheer patients, we rarely hear if their further studies have borne fruit or gone south…

And here’s another development on the dengue front.

Okay, you’ve heard vague of plenty of dengue vaccines in the pipeline or on trial. The Singapore-MIT Alliance for Research and Technology (SMART), the National University of Singa­pore, Nanyang Technological University (NTU) and the Massachusetts Institute of Technology (MIT) have engineered a single antibody that can neutralise all four serotypes of the dengue virus. It has proved successful on mice and clinical trials will start too.

And….on Parkinson’s disease

Scientists from Nanyang Technological University (NTU), and McLean Hospital and Harvard Medical School in the United States, think that anti-malarial drugs can treat Parkinson’s. They are modifying two such drugs to increase its potency and reduce side effects. If all goes well, clinical trials could start in three to five years. So that’s a long way off.

Now, about heath screening.

It’s probably a coincidence that news of a possible cancer breakthrough is coming at the same time as a doctor’s warning on over-screening for cancer. The National Cancer Centre’s Raymond Ng is concerned about service providers offering screening packages that include tests for serum tumour markers. These tests can cost over $1,000. Such tests are not based on evidence, he said, and even if they find cancer cells earlier or more cancer cells, it may not mean anything. Because the cancer cells can regress and disappear or grow so slowly that a patient might die of other causes first.

“Many of these health screening endeavours are not truly individualised according to personal risk factors despite their claims as such. In fact, the only personalised aspect of the screening appears to be based primarily on consumer request and how much he or she is willing to spend,” Dr Ng wrote in a paper published by the Academy of Medicine, Singapore.


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