He Cleared the Crap that I Created

 It’s the first day of work for the new year and the first thing that struck me about the new year was when I went to the toilet. As I was washing my hands, I noticed the guy who was paid to pick waste paper out of the bin to be placed into another bin.

It struck me that this guy, who probably worked longer hours and for less money than me, as a “working professional,” was the guy who cleaned up crap that people like me created. This was a guy who was doing something very important – he was making sure that my work environment was clean and pleasant. I, by contrast, added utterly no value to his life (unless he eats at a restaurant I’m serving at or if his employer gets liquidated – in which case he’d probably be at the wrong end of whatever I do.”)

Yet, despite the fact that his existence involved adding value to my life and my existence added f**all to his, I was the one in the position of being able to simply not notice his existence while he had a social obligation to look at smile at people like me.

Sure, I appreciate that the guy in an office has always earned more than the guy doing physical work. I also appreciate the fact that some jobs will always earn more both in terms of recognition and prestige. In the medicine, everyone loves doctors. These are the heroes that save us when we are sick and Dr. Susan Lim aside, nobody bats an eye-lid when doctors earn big bucks, because, well they save us when we’re sick. By contrast, nobody notices the nurses who do the grunt work like clean up after you puke or shit all over the place so that you are vaguely presentable when the doctor looks at you. Nurses have to study hard and know things. They have to be understanding to all sorts of lousy people in lousy modes. Yet, the only time one really appreciates a nurse is well….in some sort of sexual fantasy.

The disparity between the guys whom everyone lavishes praise and money upon and the guys who do the grunt work, was best summed up by one of our high court judges at a trial that I was working on. The lawyer introduced himself, then tried to introduce his paralegal and the judge barked “Your paralegals are not part of the bar, as far as I’m concerned, they don’t exist.”

Sure, the paralegals are not part of the bar and perhaps the judge in question didn’t want to “waste time” on certain formalities for the trial. However, the way she said what she said, summed up the attitude that our society. Certain forms of life don’t exist. As far as we’re concerned,  only doctors exist in hospitals and lawyers in courts. As far as the powers that be are concerned, the military consists only of generals.

I get that there is a reason for the pay disparity between a doctor and a nurse in as much as the doctor has had to go through certain training and is responsible for certain things that nurses cannot be held accountable for. The same is true between lawyers and paralegals or generals and foot soldiers. So, one shouldn’t begrudge the proverbial higher ups what they are getting.

However, for us as a society to lavish everything on the guys in the limelight and simply not recognize the existence of the people behind them is also a mistake. Nurses do the ground work that make it possible for doctors to shine. The star lawyer in court could only be a star because there was a team of junior lawyers and paralegals to support him. While the generals come up with beautiful plans, it’s the NCOs who get the men to fight.

Look at what happened in Covid-19. We were doing fine and were being praised by the world for conducting a master class in disease management and then there was a wild outbreak in the dormitories. Contrary to conspiracy theorist, there was probably no ill intention to our migrant workers. In the words of that high court judge “they simply didn’t exist,” and our government, which is so famous for good planning simply didn't include them in part of the plans. They didn't exist. 

Our education system has to stop stigmatizing certain people. Think of the number of times kids are told “better study hard or else you become a street cleaner.” We got to change that. The role of the forgotten people helps those of us at the front of the stage to shine. At the very least, we need to acknowledge that they exist. Perhaps, we should follow what the Japanese do and make our kids clean up after themselves so that they learn to appreciate the most basic of task and the people who have to do the  said task for a living.

Remember, they wouldn’t be making the big bucks:

 

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Life Lessons from an Eccentric Doctor

My latest guilty pleasure during this circuit breaker is a Japanese TV series on Netflix called “Dr. X – Surgeon Michiko Daimon.” Apart from the obvious charms of Ryoko Yonekura, the actress who plays the titular character, the thing that makes the show so enjoyable is a main issue for anyone living in an Asian Society, particularly if you’re the type of person who doesn’t accept things as they are.

Dr. Michiko Daimon is a freelance surgeon in a university hospital in central Tokyo. The show underlines the fact that she’s a lone wolf surgeon who “Hates Crowds” and “Hates Authority.” These characteristics clash very visibly with the culture of the hospital, which is deferential to authority and there is plenty of group think. She only gets away with her antics because she’s a brilliant surgeon who manages to do the things that no one else does.

The entire story was something relatable, especially after more than a decade as a freelance consultant in Asia, which is a part of the world that doesn’t have a culture that looks too kindly on people who stand out too obviously. Confucius, the founding philosopher of Chinese and by extension Japanese and Korean cultures, believed that everyone had a place in life and there was a great reverence for established authority, which in turn had an obligation to “look after” the people below.

While I do admire people, who can put the community above themselves, there are dangers in this approach.

The most obvious point is that the people who achieve great power aren’t always the most honourable and righteous. Even if a person starts out with the purest of intentions, a long spell in power often have a way of corrupting the best and brightest. As ethnic Chinese, I think of Mao, who lead the liberation of peasants against corrupt warlords and then ended up becoming nastier than the people he replaced. His contemporary in Vietnam, Ho Chi Minh by contrast had good fortune to die before he could go nuts.

The next point with linear or top down systems is that people in them tend to lose focus. The problem in such systems is that the only way of moving in life is either up or down. It goes without saying that if your only way of getting anywhere is based on whether the top man likes you, your focus becomes pleasing the top man. The show illustrates this perfectly. In the hospital where Dr. Daimon works, everyone is terrified of the “Professors,” who are quite often the least able to perform basic surgery. Yet, nobody questions the diagnosis of the professors and they end up doing all sorts of crap to keep on the good side of the professors, including cover up for them when dealing with mistresses. The show inevitably starts with the entire hospital rushing up stairs to greet the director (who takes the lift) to accompany him on his rounds. The most prominent incident comes when a pediatric surgeon refuses to examine a child who is complaining of various pains that occur randomly throughout her body because his boss, the Professor of Pediatrics, performed the surgery and he won’t do anything that makes his boss look bad.

While a certain amount of deference to established authority is warranted, an obsession with looking up and down is unhealthy. The problem that the hospital faces is the doctors are more focused on keeping their professors happy and the professors are only interested in their research papers. The needs of patients are ignored and this is where Dr. Daimon comes in. She’s terrible at fitting in but she acts in the best interest of patients giving them medical advice they need rather than what they want. In one episode she antagonizes a celebrity cook because she refuses to admire her cooking (which is awful). However, she is the one who rescues the celebrity who has cancer and needs surgery. She goes as far as to perform the surgery with a consent form because it is a life and death situation and that is more important than the prospect of being sued.

In hierarchical systems, the reality of becoming too obsessed with climbing the ladder and our boss’s opinion of us that we forget that the people keeping the business running are the customers. I think of my “career” path. Couldn’t make it in PR agency. Either rubbed bosses or colleagues the wrong way. Yet, as a freelancer I actually did jobs that most people would say I had no right to do as a lone individual (think Saudi Embassy, IIM and IIT).

The next point is that you got to do the work and be prepared to cast your net ass widely as possible to get information. In the first series, Dr. Diamon chats with a patient who worked in the rubber industry. From there, she realizes that the patient has allergy to latex and she quickly orders non latex gloves before the surgery. So, when she has to step in to perform the surgery, she’s able to ensure that everyone else has gloves that won’t cause the patient to have an allergic reaction.

Lesson here is to be open to things and knowledge doesn’t necessarily comes from where you expect it. As my favourite liquidator says when looking for financial shenanigans, don’t just look at financial records – simple emails can also give you plenty of information.

Dr. Diamon is also the only doctor in the hospital to check x-rays and when she questions her superiors, she’s doing so from a point of knowledge rather than taking things in on a wholesale basis. To get knowledge, you have to actually look for it.

Next point is that Dr. Diamon is good at getting people onto her side. In one instance, she concedes defeat and gets another doctor to take charge and look good. This is a doctor who refused to work with her until forced to because he didn’t trust her. It’s only as he’s been operating that he realizes that he’s doing what she wants him to do and gives her respect when she allows him to be the hero. Her main point is that she knew she couldn’t achieve the mission without his help and so is willing to give away credit

This leads to the next point, which is, although Dr. Diamon does not make “friends,” she has them. There is her “agent” Akira, who handles the money. While Dr. Diamon is a brilliant surgeon, she’s terrible with money and her agent ensures that she gets well compensated for her work. Moral of the story – work with people who will cover for your weaknesses.

Many years ago, I remember the Bishop of Lewes, who was our guest at “Speech Day” urged us to become “eccentric.” I remember this because this wasn’t something that you’d expect a guest at a public-school speech day to mention, especially when that guest was a monk.

I never quite appreciated this until I started watching Dr. X. One should not be afraid of being a little unusual. It helps shield one from the dangers of group think and when you’re not afraid to stand out from time to time, you get the chance of focusing on the things that you actually need to focus on rather than on the things that people would like you to be distracted by.

What Work Did You Do to Justify Your Charges?

Singaporeans have never been known for their sense of irony. While the population has never been known to appreciate irony, Singapore has more than its fair share of it. The most recent example of grand irony has been in the case of Dr Susan Lim versus the Singapore Medical Council.

It's ironic because the man who has been most vigorously attacking Dr Susan Lim for being "greedy" in the act of "overcharging" the Royal Family of Brunei for medical services performed between January and July 2007 has been non other than Mr Alvin Yeo, SC (Senior Counsel - Singapore's version of the QC), the Senior Partner at Wong Partnership, one of Singapore's largest local law firms. As well as being a very prominent lawyer with impecable credentials, Mr Yeo is also a Member of Parliament for Hong Kah GRC and Chairman of the Government Comity for Home Affairs and Law. He also serves on the board of directors for a number of public listed companies.

Mr Yeo has spent the better part of the month trying to show the world that Dr Lim is a greedy little money grabbing tart who has abused the noble profession of medicine to make money. As far as Mr Yeo has been concerned, Dr Lim has betrayed every standard of ethical propitiatory in order to chase the almighty dollar. Leaving aside the merits of Mr Yeo's case into Dr Lim - one might be tempted to ask Mr Yeo is he's guilty of the very things that he's been accusing Dr Lim of.

Let's put things in perspective. As excessive as Dr Lim's S$25million bill may sound, it was a bill that was issued by a thriving medical business and it was for work done over a period. The fact is, had that S$25 million been paid, most of the money would have gone to cover expenses that Dr Lim incurred by caring for the patient, including the building of an ICU infrastructure and transplanting it via private jet (paid by her business). Fact remains that of that S$25million, Dr Lim would probably only received S$3.5 million, which was her annual salary for running the group.

Dr Lim does run a vast and very successful operation, which was recently valued at some S$80million. While this fact may not endure her to Singaporeans who are convinced of her greed, Dr Lim has been a successful entrepreneur as much as she's been a doctor. She has placed her personal money into the operation. She has taken on personal risk in starting an enterprise and it's a rule of business that the person who takes on the risk gets the lion's share of the rewards for the success of the business (she would also take the lions share of the cost if the business fails). Dr Lim may be making a lot of money, but she is also responsible for feeding over 30 people as well as caring for her patients. In short, that hefty salary that she earns is measured by the work that she does. If she fails in her work, not only does she lose her business and work but at least 30 additional souls get thrown out of work.

Mr Yeo by contrast has it relatively easy and like Dr Lim, he's no pauper. If Dr Lim can be accused of running a "scam," Mr Yeo's "scam" makes Dr Lim's look like child play. Mr Yeo has found a way of minting money without assuming any of the risk and responsibility that Dr Lim has.

Let's start with his day job. As the Senior Partner at Wong Partnership, one can expect Mr Yeo to take home nothing less than S$50,000 a month. What exactly does he do to earn this money? Well, just as no one doubts Dr Lim's talents as a surgeon, nobody is doubting Mr Yeo's talents as a litigator. I've heard him argue. He's articulate and logical when he presents his case. He's also good at disturbing his opponents. He knows how to play up to the public gallery as much as he does the judge.

So, I guess you could say Mr Yeo deserves his money from his day job in that many of the firms clients are there because of him. However, most of the leg work is done by his juniors (approximately 300 lawyers under him and let's not forget the paralegals) and let's face it - Mr Yeo was the founder of his firm and the personal risk he faces from the success or failure of the firm are negligible, especially when compared to the risk that Dr Lim faces.

While Dr Lim's income is derived from the business she has started and runs, Mr Yeo has done something even better. He's found a host of part-time jobs the supplement the income he makes from his full time job. His part time jobs also involve very little actual work for generous pay.

Let's start with his various directorships. What exactly does a board of directors do in public company? The answer is they look after the interest of the shareholders and they keep the CEO on his toes. The board of directors does not get involved with the day-to-day management of the company and they get paid not ungenerous fees to attend the usual yearly annual general meeting. They protect the shareholders by signing off on the report presented to them by the CEO and signed off by external auditors. So, if you think about it, what Mr Yeo is doing is very clever. He attends enough board meetings to enjoy enough swanky meals. Reads through a few annual reports and gets paid a decent sum for say a days work.

His directorships are, however, nothing when compared to his main part-time job - namely that as Member of Parliament for Hong Kah GRC. What does this part-time job take from him and give to him?

The answer is simple. He is required to listen to his constituents whine for about an hour a week. Once in a while he may be required to visit a few people and may be grace a few events. His comity work will involve maybe another two hours a month.

In return for doing all of this, he receives an allowance (Note - this is an ALLOWANCE not a SALARY) of a mere S$15,000 a month (around S$1,875 per hour worked). As long he serves two terms (10-years), he's entitled to this for life. He is also entitled to a pension which around two thirds of the allowance.

What he does not receive in money, he more than makes up for in the prestige of being a Member of Parliament. Wherever he goes, people will be aware of the fact that not only does Mr Yeo argue laws, he has a role in making them.

What risk does this part time job entail? Well, in theory he has to face the voters every five-years. However, Hong Kah has been a "walk-over" constituency - so he's never had to face the buggers who pay him for visiting them. Then let's look at this way - the work that he needs to do for his weekly visits are actually performed by volunteers in the grassroots.

As an MP, Mr Yeo is running one of the most impressive enterprises in the world. Everything that you make is gross and net to you. The cost are either borne by the State or by volunteers who want nothing better than the chance to say they licked your boots.

At the very least, Mr Yeo makes S$65,000 a month. This figure may not be as impressive as the S$25million that Dr Lim is supposed to have billed. However, it's far more secure. To date, Dr Lim has yet to receive a penny for the work that she did. The cost have had to be written off. By contrast, Mr Yeo's monthly salary is guaranteed and long as he stays within the comfort of his full and part-time job.

Which leads to the question? Why does Mr Yeo need to have an MP's allowance and pension when he's making the money he's making? Then you have to look at the fact that Mr Yeo, like Dr Lim is doing "Noble" professions. Lawyers are supposed to be interested in justice rather than in money. Being a Member of Parliament is ALL ABOUT SERVICE TO THE COMMUNITY. The member does NOT receive a SALARY but an allowance to cover things like transport (which in Singapore is negligible).

So, why doesn't Mr Yeo public ally announce that he's going to forgo one of his incomes and continue to do two jobs. That would be called "service to the community." His income as a the Senior Partner at the Wong Partnership is more than enough to cover the expenses he runs up on state business as an MP.

Mr Yeo made this point in court - "What work did Dr Lim do that could possibly justify her charges?" I would like to ask Mr Yeo the same thing - a significant portion of his income does not come from the Sultan of Brunei - it's comes from people like you and me.

Is there such a thing as a Noble Profession?

Thanks to Dr Susan Lim, everyone is once again obsessed with our favourite past-time - money and talking about it. If you talk to enough people, you'll find that everybody is exceedingly upset with Susan Lim for having the audacity to make money. It has even reached the stage where Susan Lim has become a verb for "overcharging."

The fact that Dr Lim never made money off the general public is irrelevant. The fact that she's in private practice and very successful because she's very good at what she does is also irrelevant. As far as a most people in the streets of Singapore and in cyberspace are concerned, Dr Susan Lim is a symbol of a greedy healthcare system that's milking the poor.

As far as most of the chat rooms are concerned, Dr Lim is wrong because she wants to make money. Talk to enough people about the case and they'll tell you that -"If you want to make money you should be a banker not a doctor," or "Doctors are supposed to save lives not make money." One journalist even went as far as to remind me,"She has a Hippocratic Oath to save lives."

It seems that the thing that's making people very upset with Dr Lim is the fact that she runs a very successful business? Yes, like it or not, a private medical practice is a business with rents and staff who need to be paid. Yet, because private medical practices are ..."Medical" they're supposed to be about something more than just paying the bills and turning a profit.

There are, as they say, professions and professions. Some professions are about making money. Nobody seems to mind when stock brokers make money - they wouldn't be stock brokers otherwise, would they? Then there are professions that notorious for keeping people broke - writing is one of them. Then there are what you call the "Nobel" professions, which are supposed to be about the greater good of mankind rather than making money. However much these professions don't make - they carry an aura of respectability about them.

I take teaching as an example. Teaching is known for being badly paid. Yet, it is a "noble" profession and being a teacher or a school master carries a certain aura to it, which money apparently cannot buy. I remember my late step-grandma who said that she was always relieved when step-grandpa went back to school, it was time when she could hold her head up high and tell the world that she was "Mrs Hart Smith." Step-grandpa Hart worked in the days when teachers did not get paid during holidays. So, he became a salesman for World Book. He made A LOT more money a salesman than he did as a teacher. Yet, as far as the community was concerned, his respectability came from being a teacher.

In a way, doctoring is supposed to be like teaching. Like the teacher and the lawyer, the doctor is a learned man. In addition to being learned, the doctor also saves lives. I think of Dr Christopher Khng, one of my ophthalmologist who teaches and operates on eyes. He says,"When you do good operation you help one person - but when you teach ten people how to do a good operation you help ten times the people." Doctors wear white coats, the colour of purity.

I enjoyed working in the healthcare space. It helped me to understand certain medical conditions and it helped me do some good by getting people I knew to look after their eye-sight.

However, as much as doing good is exceedingly satisfying, I am left wondering if there's such a thing known as a noble profession any more?

It started out with Singapore's politicians. It's a well known fact that Singapore has the world's HIGHEST PAID POLITICIANS. American politicians make their fortune after politics. Here, the politicians have a fortune thrust upon them. Our President, who is primarily a ceremonial figure who's main function seems to be shaking hands once a year on National Day only make some S$4 million a year.

When a few of us grumbled, the politicians made the point that high salaries for PUBLIC SERVANTS was necessary because the nation needed to get bright young things in PUBLIC SERVICE and to stay there. The politicians also made the point that highly paid PUBLIC SERVANTS did not shake down the poor for bribes. Much better to keep a PUBLIC SERVANT content with his lot so that he focuses on the job on hand.

If you think about it, this is a sound argument. Yes, we expect our PUBLIC SERVANTS to be noble people who want to serve society rather than engage in the grubby world of commerce. However, we understand that they need to live and if they see the possibility of living comfortably they're less likely to steal from us. Singapore is close enough to places where being an honest person is akin to being supernatural - able to function without life's basic necessities.

So, we've already bought the idea of the necessity of PUBLIC SERVANTS in NOBLE Professions being handsomely paid.

The next step is to look at the obvious - if we can accept the argument that PUBLIC SERVANTS must be well paid - surely the same argument applies to other so called NOBEL PROFESSIONS.

Then, let's look at the facts - the "Nobel professions" have already been industrialised. Let's go back to the example of teaching. Teachers may be a "noble" lot dealing with something other than money, but education is most certainly an industry and the teachers are slowly but surely realising that what they do for a living is a skill that can be packaged and sold just like any other.

Let's look at America as an example. America has the world's BEST universities. Places like Harvard, Princeton and Yale consistently rank amongst the world's top ten. How do these universities do it? Well, it's simple - they produce the guys who will get hired and promoted to top levels of the corporate sector. This in turn makes them more attractive as places to study and people are willing to pay vast sums of money to get in. If you are brainy but broke, the university has scholarships, bursaries and other schemes to help you out - but the bottom line is - the university still gets paid for providing you with a service.

The universities with the most successful business continue to climb world rankings. Those that fail - die. Nobody denies that Harvard is expensive - nobody denies that Harvard is a WORLD CLASS institution. The rules are simple - if you don't like Harvard's fees - you don't go there.

This is as business like and mercenary as it gets. While the American University system is acknowledged as the world's best despite it's mercenary nature, the same is not true lower down the education ladder. American High Schools are funded by the tax payer and any kid can goto high school. When you think of American High Schools, you usually think of a war zone in the same way that you think of an American University as a centre of excellence.

The Europeans who once stood out as the bastion of mass education have learnt the lesson. Business methods work in the supposedly noble business of education. European universities are now charging students for the service of teaching. In the UK, the universal truth remains - the schools that are run like businesses (misleadingly known as public schools) still produce the bulk of graduates at elite levels.

Teaching may be a noble profession but education is big business whatever anyone tells you. I live in Singapore where teaching is an industry. Local publishers survive on text book publishing. Parents spend good money on old exam papers so that they're kids can pass. Not all teachers are civil servants working in schools. If you're unemployed, become a tutor - you'll always have work. If you're entrepreneurial, you should also be a tutor. Retired school teachers with a name, make a very good living either by teaching only children of the well to do or setting a mass market tuition centre.

What is true of education has been more true of health care. Health care is, like it or not an industry in its own right. The doctor may be "noble" and willing to work for free but he or she would not be able to afford to provide you with basic health care without the people who make the equipment and the medicines. Nobody is suggesting that it's wrong for GlaxoSmith Kline or Norvartis not to charge money for their research, development and production.

Say what you like about big pharmaceutical companies but they've produced life saving stuff. Think of Asprin, which seems to cure just about anything. Think of HIV medications - which remain prohibitively expensive for many but have also given many others the chance to live healthy normal lives. More will be done in the field of pharmaceutical healthcare - however, someone has to pay for this and ultimately it's the consumer.

Doctors are part of this industry whether we like it or not. The industry that produces many of the miracle drugs we now take for granted, relies on the feedback of doctors.

Much as we hark back to the ideal of a doctor being all about saving lives no matter the financial status of the life to be saved, it is just that - an ideal. Doctors need to live too and the more well looked after they are, the more they are able to focus on the business of saving lives.

This is especially true of private practice. Doctors in private practice may not like to admit it but they are running a business and you cannot expect them to work on nothing but the love of it. The doctor may want to save your life for free - but the industry that supplies him will want him to pay for the medication and the landlord of his practice will expect to be paid. The staff of the practice will also expect their salaries.

Let's face it, the doctors who make it big in private practice are good at what they do or at least they're good enough for people to open their wallets. The Susan Lim's, Julian Theng's and Ron Yeoh's of this world are darn good at what they do - hence they get people who are willing to pay them top dollar.

I've always believed that life has to be about something more than just money. However, to expect people to provide you with something for nothing is unrealistic. Money is necessary in order to get progress. You need that to fund things like research and development. The money has to come from somewhere and more often than not, it is from the consumer and tax payer.

It's also proven that systems that have an element of business to them tend to be better at providing the basic service. If I had ten high paying clients, I could focus on just ten. My concentration for every client would be better than if I had to service a hundred poor paying ones. You like at the difference between the American University System and High School system as the best comparison.

Noble professions are not immune from the basic rules of business. Education, healthcare and dare I say legal systems are becoming more industrialised and not all of this is bad.

While noble professions may be less so, that does not exclude people from being noble. My favourite litigator devotes an incredible amount of time to "bro-bono" work and he's not the only lawyer doing it. His argument is that he believes in a system and the work he devotes to cases like Zen and Eric is a way of paying providence for giving him clients like Zim.

The same is true for doctors. Susan Lim may have charged Pangiran Damit millions, but she has given free surgery before. Dr Ron Yeoh has a lucrative eye care practice in Camden Medical centre serving an elite client el, but he and his team continue to do work at the National Eye Centre (SNEC).

Doctors and lawyers do give away pro-bono work. However, they have to get the money from somewhere to keep their practices flowing.

You cannot expect people to be noble without any consideration to their ability to take care of themselves. As one taxi driver says - "You cannot expect me to treat you like you are in a restaurant but pay me a Kopi Diam rate."