Professor John Wong, Chief Executive, National University Health System

 Prof John Wong was also Honorary General Secretary of the NUS Medical Society in 1977/1978 and it is an honour to have him share his thoughts on medical education and other healthcare matters. In this first part, we hear him talk about his life before medical school as well as what medical education was like in the past.    What is your most cherished memories from schooling days?   From JC, probably playing squash and at that time RI, had one of the first squash courts and we had one of the first tennis courts and we also had a 50m swimming pool. This was the RI at Grange Road because when I was in Sec 3 we moved from Bras Brasah to Grange Road. So in sec 4, it was great we had squash courts, 50m swimming pool, tennis courts and I spend a lot of my time (there).    Why did you choose to become a doctor?   I was exposed (because) both my parents are doctors. My mother’s father is a doctor, my mother’s siblings are all doctors and they all got married to doctors. And so I was exposed to medicine as (the) third generation a lot. My parents really told me to think very hard about doing Medicine. My parents really didn’t want me to do Medicine so it was just something I really wanted to do. So, I thought that there are not many jobs that you can do something which is meaningful, intellectually very stimulating and as long as you are willing to work anywhere, you can always get a job. There’s always going to be a demand for doctors. So for those three reasons, you can do something good and meaningful, at the same time it is intellectually very stimulating and as long as I was willing to work anywhere, I could always find a job.    If it was not for Medicine, what other jobs would you have considered?   I thought about being a teacher. I sort of like the humanities. I liked chemistry, I liked biology but I wasn’t very good at physics. My math was okay until A levels. But teaching was just something that appealed to me. Being an archaeologist appealed to me because I like history. I did think about the clergy. I also did think about joining the foreign service because I like to travel.    How was studying Medicine like in the past?   I think that all of you currently have a lot of things that we didn’t have before. I entered medical school in 1976 and the first one and a half years were mainly lectures and practicals, you know dissection, biochemistry, physiology. We had tutorial groups but mainly it was to go over the results of the experiment. So we didn’t have the technology that you currently have. We certainly didn’t have the simulation centre that you currently have. It was basically one and a half years in the class room and three and half years of clinical. I think there was a lot of self teaching. I can honestly say that I had great difficulty going to afternoon lectures from third year onwards. I use to stay at KE Hall. I use to go for afternoon lectures but I could not just stay awake. And one of my greatest fear when I graduated was whether I would be able to work in the afternoon because (during medical school) the afternoons I would end up sleeping then wake up (and it was) time to go play basketball. (I) Probably only go to the library after dinner. I would say that currently the curriculum is far more structured and you get far more structured teaching now than before. Before a lot was left for students to learn on their own.

Prof John Wong was also Honorary General Secretary of the NUS Medical Society in 1977/1978 and it is an honour to have him share his thoughts on medical education and other healthcare matters. In this first part, we hear him talk about his life before medical school as well as what medical education was like in the past. 

What is your most cherished memories from schooling days?

From JC, probably playing squash and at that time RI, had one of the first squash courts and we had one of the first tennis courts and we also had a 50m swimming pool. This was the RI at Grange Road because when I was in Sec 3 we moved from Bras Brasah to Grange Road. So in sec 4, it was great we had squash courts, 50m swimming pool, tennis courts and I spend a lot of my time (there). 

Why did you choose to become a doctor?

I was exposed (because) both my parents are doctors. My mother’s father is a doctor, my mother’s siblings are all doctors and they all got married to doctors. And so I was exposed to medicine as (the) third generation a lot. My parents really told me to think very hard about doing Medicine. My parents really didn’t want me to do Medicine so it was just something I really wanted to do. So, I thought that there are not many jobs that you can do something which is meaningful, intellectually very stimulating and as long as you are willing to work anywhere, you can always get a job. There’s always going to be a demand for doctors. So for those three reasons, you can do something good and meaningful, at the same time it is intellectually very stimulating and as long as I was willing to work anywhere, I could always find a job. 

If it was not for Medicine, what other jobs would you have considered?

I thought about being a teacher. I sort of like the humanities. I liked chemistry, I liked biology but I wasn’t very good at physics. My math was okay until A levels. But teaching was just something that appealed to me. Being an archaeologist appealed to me because I like history. I did think about the clergy. I also did think about joining the foreign service because I like to travel. 

How was studying Medicine like in the past?

I think that all of you currently have a lot of things that we didn’t have before. I entered medical school in 1976 and the first one and a half years were mainly lectures and practicals, you know dissection, biochemistry, physiology. We had tutorial groups but mainly it was to go over the results of the experiment. So we didn’t have the technology that you currently have. We certainly didn’t have the simulation centre that you currently have. It was basically one and a half years in the class room and three and half years of clinical. I think there was a lot of self teaching. I can honestly say that I had great difficulty going to afternoon lectures from third year onwards. I use to stay at KE Hall. I use to go for afternoon lectures but I could not just stay awake. And one of my greatest fear when I graduated was whether I would be able to work in the afternoon because (during medical school) the afternoons I would end up sleeping then wake up (and it was) time to go play basketball. (I) Probably only go to the library after dinner. I would say that currently the curriculum is far more structured and you get far more structured teaching now than before. Before a lot was left for students to learn on their own.

 In this second part, we explored Prof Wong’s life as a medical student as well as some personal thoughts on the younger generation of doctors.   What activities were you involved in?   Debating, I use to debate for KE hall. Rugby, that was for Medical Faculty. Rag & Flag I was involved a lot. That would probably be the three official areas.   How was your experience as Honorary General Secretary of the Medical Society?    The Medsoc was (doing) a fraction of what it is currently doing right now. There was a canteen which everyone used to gravitate towards called Ah Ling’s Canteen. Next to Ah Ling’s canteen was a small building in which the Medsoc has one room in that building. Because the medsoc room was next to the football field, I think that’s why many people heard about the medsoc but meetings were short because most of the time we would end up on the football field. When I was in medsoc, as the Honorary Secretary General, I am embarrassed to say we probably didn’t do anything memorable. The medsoc now is very different than what the medsoc used to be before. And I think now you have several flagship programs going, you have the Neighbourhood Health Sceening, which to me, is really transformational. It would be useful to have a 10th anniversary because it is probably one of the most dramatic programs that transformed the way people think about healthcare in Singapore.   How do you think doctors in the past differ from the younger generations of doctors?   I belong to a generation where you look at some of my teachers who are still teachers. Prof Lim Pin he was head of medicine when I was a medical student. He was my examiner in the clinical skills foundation and I still keep on reminding him about it because he terrified me. Prof Lim Pin is still working full time, he was head of medicine, then he became vice chancellor of NUS and now he is back as a member of the faculty. Prof Shanmugaratnam, who is DPM Tharman’s father was head of pathology when I was a medical student and Prof Shanmugaratnam worked all the way until he was 94 years old, full time. There is a sense of purpose and a sense of that you really love medicine. I do think that your (younger) generation is incredibly talented and you all are older than your years because you have been exposed to so much. But there are some things that come with time, experience, going through challenges which would help shape you.  I come from a generation where we used to work easily 100 hours (a week). It’s not something I would recommend, but there was a certain dedication that you don’t go home if your patient is not stable. And if you did go home you always make sure that you do everything to hand over to the on call team. That patient was really your patient, you really take ownership of the patient. Ultimately I still think that fundamentals don’t change but I think every generation worries about the next so I’m sure Prof Lim Pin must have been pretty worried about my generation so I hope I haven’t let Prof Lim Pin’s generation down. I’m sure my generation worries about your generation also because ultimately you are going to be the future consultants and leaders of Singapore healthcare.    What advice would you give your younger self?   I think that you need to have discipline, you need to have a sense of purpose. And I think you have to be able to look at yourself in the mirror and be comfortable with what you see. There’s a story going around that the Japanese Samurai carried 3 things with them. Their sword, which they are not meant to draw but when they draw they better know how to use it. To me the sword is your excellence, you know you need to have something which is really going to be truly excellent because your life really depends on it. They also carry salt. The salt is a symbol of purity. I heard that it is also meant to be so you can live off the land because everything taste good with a little bit of salt but apparently it is more for purity. And the third is a mirror. The Japanese Samurai wanted to look in the mirror and reflect upon themselves. So I think being able to reflect is a very important thing to do because if you don’t reflect, you tend to do a lot of things and don’t think of the consequences.

In this second part, we explored Prof Wong’s life as a medical student as well as some personal thoughts on the younger generation of doctors.

What activities were you involved in?

Debating, I use to debate for KE hall. Rugby, that was for Medical Faculty. Rag & Flag I was involved a lot. That would probably be the three official areas.

How was your experience as Honorary General Secretary of the Medical Society? 

The Medsoc was (doing) a fraction of what it is currently doing right now. There was a canteen which everyone used to gravitate towards called Ah Ling’s Canteen. Next to Ah Ling’s canteen was a small building in which the Medsoc has one room in that building. Because the medsoc room was next to the football field, I think that’s why many people heard about the medsoc but meetings were short because most of the time we would end up on the football field. When I was in medsoc, as the Honorary Secretary General, I am embarrassed to say we probably didn’t do anything memorable. The medsoc now is very different than what the medsoc used to be before. And I think now you have several flagship programs going, you have the Neighbourhood Health Sceening, which to me, is really transformational. It would be useful to have a 10th anniversary because it is probably one of the most dramatic programs that transformed the way people think about healthcare in Singapore.

How do you think doctors in the past differ from the younger generations of doctors?

I belong to a generation where you look at some of my teachers who are still teachers. Prof Lim Pin he was head of medicine when I was a medical student. He was my examiner in the clinical skills foundation and I still keep on reminding him about it because he terrified me. Prof Lim Pin is still working full time, he was head of medicine, then he became vice chancellor of NUS and now he is back as a member of the faculty. Prof Shanmugaratnam, who is DPM Tharman’s father was head of pathology when I was a medical student and Prof Shanmugaratnam worked all the way until he was 94 years old, full time. There is a sense of purpose and a sense of that you really love medicine. I do think that your (younger) generation is incredibly talented and you all are older than your years because you have been exposed to so much. But there are some things that come with time, experience, going through challenges which would help shape you. 
I come from a generation where we used to work easily 100 hours (a week). It’s not something I would recommend, but there was a certain dedication that you don’t go home if your patient is not stable. And if you did go home you always make sure that you do everything to hand over to the on call team. That patient was really your patient, you really take ownership of the patient. Ultimately I still think that fundamentals don’t change but I think every generation worries about the next so I’m sure Prof Lim Pin must have been pretty worried about my generation so I hope I haven’t let Prof Lim Pin’s generation down. I’m sure my generation worries about your generation also because ultimately you are going to be the future consultants and leaders of Singapore healthcare. 

What advice would you give your younger self?

I think that you need to have discipline, you need to have a sense of purpose. And I think you have to be able to look at yourself in the mirror and be comfortable with what you see. There’s a story going around that the Japanese Samurai carried 3 things with them. Their sword, which they are not meant to draw but when they draw they better know how to use it. To me the sword is your excellence, you know you need to have something which is really going to be truly excellent because your life really depends on it. They also carry salt. The salt is a symbol of purity. I heard that it is also meant to be so you can live off the land because everything taste good with a little bit of salt but apparently it is more for purity. And the third is a mirror. The Japanese Samurai wanted to look in the mirror and reflect upon themselves. So I think being able to reflect is a very important thing to do because if you don’t reflect, you tend to do a lot of things and don’t think of the consequences.

 In this third and final part, we talked about Prof Wong’s career and what he feels are some of the pressing issues the healthcare sector faces. Read till the end to see a little tidbit where Prof Wong let us in on what he does in his free time.    What made you keen to take on the additional role and responsibility of a CEO on top of a doctor?   So in 1997 I was vice dean and then in 2000 I was chairman of the medical board in NUH and In 2003 I was dean. So yeah I’m helping look after the health system. But you will discover when you practice, there are always things in the system that could be better. So we have a choice, either we fix the system or we ask somebody else to come and fix the system. I always felt that some of the best solutions come from within the systems. So I see myself as doing this and when I finish like Prof Lim Pin, I want to come back and be a member of the faculty.    Do you think your experience in medical school help you in your current role?   Of course, I mean all experiences help you, for better or for worse. One advantage of our class it was only a 119 people. Well it was a 120 but one person left after the first year. At that time the class size was a 120. We knew the year ahead, the year below and probably, I would say we knew the 5 years. So I was final year when minister Vivian Balakrishnan was a first year. Prof Ivy Ng and Dr Ng Eng Hen were a year behind me. Prof Tan Chorh Chuan was two years behind me (and) we all know each other really well. So when you know people below and above really well and you know who you can call for help and that is a really important skill that all of you need to have. You must be able to call for help. You will never be able to do everything on your own or know everything. I have a very low threshold for calling for help. It helps if you know who you can call and who you know would help you. So that is another issue because now I know most of you don’t stay in halls and most of you stay at home. And how well do you know, firstly your year because now your class is 300 and how well do you know the years above and below you. Because you are working as an ecosystem. And so you must know who you can call for help and who you can trust and when you call for help who would help you.   In your opinion, what is the most pressing issue facing the healthcare sector now?   I would probably say that there are 3+1 pressing issues. The first pressing issue is that we got one of the fastest ageing population in the world. Unfortunately that population is not a healthy population. Our prevention and screening and early diagnosis is not very strong. So we have far more chronic disease that we should have. The second challenge is the generation before you and your generation have actually stop having children, so Singapore workforce is falling very rapidly. Unfortunately, immigration to the extent of reversing our demographics is not possible because it is such a sensitive issue. Our birth rate is falling faster than immigration can allow us to keep up with it. Unfortunately healthcare is still a very labour intensive sector. People fall sick they still want to see a person, they don’t want to see a machine. The third big challenge is our rate of expenditure in healthcare is going up at a gradient which is not sustainable so we cannot just keep pouring money into this. So those are the 3 big factors, the +1 is that we really need to strengthen our community care. We have been far too hospital centric. Because our whole goal should be to try to provide what we do in the hospitals but in the community. Because first, the patient don’t want to be in the hospital. Our whole goal should be to convert every person’s home into a ultimate hospital bed and ultimate clinic. Now to do that, you need to have healthcare professionals working in the community, of the same standard as they are in the hospital. But then you need to have the technology to enable that to happen. But that is what we really need to do because we can’t keep on building more and more hospitals.    What do you do in your free time?   I do have a family. I still like to run, helps me clear my head. One thing which has suffered, I used to read outside of medicine much more. But now I just barely have time to keep up with the journals and the news so I haven’t been able to read as much as I used to.

In this third and final part, we talked about Prof Wong’s career and what he feels are some of the pressing issues the healthcare sector faces. Read till the end to see a little tidbit where Prof Wong let us in on what he does in his free time. 

What made you keen to take on the additional role and responsibility of a CEO on top of a doctor?

So in 1997 I was vice dean and then in 2000 I was chairman of the medical board in NUH and In 2003 I was dean. So yeah I’m helping look after the health system. But you will discover when you practice, there are always things in the system that could be better. So we have a choice, either we fix the system or we ask somebody else to come and fix the system. I always felt that some of the best solutions come from within the systems. So I see myself as doing this and when I finish like Prof Lim Pin, I want to come back and be a member of the faculty. 

Do you think your experience in medical school help you in your current role?

Of course, I mean all experiences help you, for better or for worse. One advantage of our class it was only a 119 people. Well it was a 120 but one person left after the first year. At that time the class size was a 120. We knew the year ahead, the year below and probably, I would say we knew the 5 years. So I was final year when minister Vivian Balakrishnan was a first year. Prof Ivy Ng and Dr Ng Eng Hen were a year behind me. Prof Tan Chorh Chuan was two years behind me (and) we all know each other really well. So when you know people below and above really well and you know who you can call for help and that is a really important skill that all of you need to have. You must be able to call for help. You will never be able to do everything on your own or know everything. I have a very low threshold for calling for help. It helps if you know who you can call and who you know would help you. So that is another issue because now I know most of you don’t stay in halls and most of you stay at home. And how well do you know, firstly your year because now your class is 300 and how well do you know the years above and below you. Because you are working as an ecosystem. And so you must know who you can call for help and who you can trust and when you call for help who would help you.

In your opinion, what is the most pressing issue facing the healthcare sector now?

I would probably say that there are 3+1 pressing issues. The first pressing issue is that we got one of the fastest ageing population in the world. Unfortunately that population is not a healthy population. Our prevention and screening and early diagnosis is not very strong. So we have far more chronic disease that we should have. The second challenge is the generation before you and your generation have actually stop having children, so Singapore workforce is falling very rapidly. Unfortunately, immigration to the extent of reversing our demographics is not possible because it is such a sensitive issue. Our birth rate is falling faster than immigration can allow us to keep up with it. Unfortunately healthcare is still a very labour intensive sector. People fall sick they still want to see a person, they don’t want to see a machine. The third big challenge is our rate of expenditure in healthcare is going up at a gradient which is not sustainable so we cannot just keep pouring money into this. So those are the 3 big factors, the +1 is that we really need to strengthen our community care. We have been far too hospital centric. Because our whole goal should be to try to provide what we do in the hospitals but in the community. Because first, the patient don’t want to be in the hospital. Our whole goal should be to convert every person’s home into a ultimate hospital bed and ultimate clinic. Now to do that, you need to have healthcare professionals working in the community, of the same standard as they are in the hospital. But then you need to have the technology to enable that to happen. But that is what we really need to do because we can’t keep on building more and more hospitals. 

What do you do in your free time?

I do have a family. I still like to run, helps me clear my head. One thing which has suffered, I used to read outside of medicine much more. But now I just barely have time to keep up with the journals and the news so I haven’t been able to read as much as I used to.