Wednesday, May 2, 2012


Apr 27, 2012

Replace MCs with honour system

I AM a doctor in a public primary health-care institution, and am currently on a six-week attachment at a hospital in San Francisco to learn some of their best practices. My hosts here have heard many good things about Singapore and its health-care system and are as keen to learn from me as I am from them.

One thing which I have found difficult to explain to them is the fact that many of our patients are those seeking medical certification for sick leave, adding to our already overloaded system ('Beefing up the Employment Act'; Wednesday).

It is ridiculous that people who are entrusted with carrying firearms, administering medication, making financial decisions on behalf of others or educating our young are not trusted to call in sick on their own without having to visit a doctor first.

Often, patients just need a day of rest with some medication which they can easily obtain from a pharmacy before going back to work reinvigorated.

In San Francisco, people are entitled to some 10 to 14 days of sick leave a year. If they take sick leave beyond a certain period, they are then required to produce a sick note. Otherwise, it is based on an honour system which seems to work well.

I wonder if the Ministry of Manpower will consider removing the need for sick leave to be certified by a doctor as is stated in the Employment Act. It could limit the need for a doctor's certification only for sick leave of three days or more.

This will greatly reduce the strain on public resources, freeing up time in the doctors' consulting rooms for those patients who truly need the time, as well as empower employees to take better charge of their own health.

I am sure the different organisations can come up with their own incentive programmes to ensure that employees stay healthy.

Dr David Tan Hsien Yung

May 2, 2012

Honour system can work - within limits

I AM surprised by the reactions of employers, human resource personnel and even general practitioners ('Honour system won't work, say bosses and HR experts'; yesterday) to Dr David Tan Hsien Yung's proposal ('Replace MCs with honour system'; last Friday).

Of course, not all their concerns are unfounded, but they fail to see the merits of the honour system by making some fairly sweeping assumptions:

  • That employees will 'abuse' the system of trust: What this shows is management's distrust of employees. Should the work be decent, the environment conducive, the compensation and rewards commensurate, and employer-employee relations cordial, which level-headed worker would abuse the system by skiving?
  • That some conditions, albeit minor, ought to be attended to by qualified doctors: When I was working in the public health-care sector, I could attend to as many as 80 to 90 cases of 'coughs, colds, tummy aches and fevers' in a 41/2-hour morning session. I wonder what quality health care I was expected to deliver.

A good 80 per cent of those patients could well have told me their diagnoses outright, and a similar number would probably have enough medication, or were capable of buying some over the counter, for their ailments; they just needed the all-powerful medical certificate (MC). Imagine how many truly ill people I could have attended to instead.

However, the honour system for sick leave must not be applied unbridled. There must be checks and balances:

  • Absence of three consecutive days or more must be supported by a doctor's assessment and medical certification.
  • Total sick leave allowed in a year can still be capped at 14 days, beyond which additional certification requirements may be imposed.
  • Sick leave is factored into the worker's performance appraisal; this incentivises employees who take care of their health.
  • Declaration of sick leave must be made early, so that companies that are reliant on specially trained workers have reasonable time to arrange for workarounds or replacements.
  • Sick leave without MCs can be off limits to select groups of workers, such as contract or temporary staff.
  • Sick leave can be lumped together with annual leave (and other leave) as a complete paid leave benefits package.

Our manpower policies should evolve in tandem with a maturing and more discerning workforce. I urge the Manpower and Health ministries to study Dr Tan's proposal seriously.

Dr Irwin Clement Chung

[I agree.

So you thought I was going to bash the suggestion for being idealistic and naive? Really, we have a more educated, more matured workforce and we have to apply a more progressive approach, or we will end up with doctors issuing MCs simply for minor ailments that could be self-medicated with over-the-counter medication and some rest.

We don't have enough doctors for this kind of nonsense. Certainly, the best way might be to just give say 5 days of urgent leave which any staff can use for any emergencies including sick leave, in addition to the annual leave package of 14 days (or whatever is mandated by law). Why 5 and not 14? Most people on average take less than 5 days of MC. Sick leave over 5 days will need an MC, and if there are reasons for frequent sick leave (medical history, chronic illness), the employer should extend the amount of emergency leave for such employees.

Alternatively, give 14 days of casual leave, of which 9 days if not used at the end of the calendar year, can be converted to a cash bonus. Why not all 14 days? To discourage sick employees who refuse to take sick leave.]

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