What Susan Lim’s fees mean

Many Singaporean chatterers had been agogged for some time now about the reumoured amount of fees that surgeon Susan Lim was supposed to have charged a Bruneian patient — said to be related to the Sultan of Brunei.

Yet those stories would have remained just stories to be whispered with raised eyebrows between delicious sips of Dom Perignon at those super uppercrust parties. The numbers sounded astronomical even by the standards of the super rich. Unbelieveable fictional titter tatter by the standards of you and me in our middle to lower middle class ignorance.

bills at a glance

Now, the stories are no longer stories. They are facts. As revealed in their jaw-dropping details by the Singapore media following Dr Lim’s application for a judicial review to stop the Singapore Medical Council from forming a second disciplinary committee, after the first stepped down following accusations of having pre-judged the case.

For a sampling of media reports, click susanlim.

Here are my random thoughts on Dr Lim’s bills.

First, they shed light retrospectively on the earnings stories that swirled around current Minister for Education Ng Eng Hen when he joined politics a couple of elections back.

It was said then that he took a hefty pay cut to become a politician, as his earnings as a top breast surgeon were in the million$.

There were sceptics.

Now in the light of Dr Lim’s bills for just one patient, the pay packet of Dr Ng shouldn’t be that incredible after all!

Another thought which comes to mind is thank heaven that the majority of us have access to state funded hospitals where the charges, tho going up relentlessly, are nowhere near what Dr Lim charges!

Thus her bills should help Singaporeans grumbling about ever-rising hospital and doctor expenditures have better perspective on their medical money woes!

A third thought is why this fuss about Dr Lim’s bills? Isn’t Singapore all about free market, pro choice and cavet emptor?

So, she’s a doctor and had sworn the Hypo-what’s-it oath. So what? It isn’t as if there’s a dearth of doctors in Singapore. And sick people haven’t any choice but to go to her!

 If she overcharges as seems to be the conclusion of anyone looking at the face value of the bills, then won’t she go out of business quickly, since there’s competition aplenty in her skill-band?

However, if her charges match the rarity of her skills as well as her personal decision to ration them to those who can afford her, then isn’t it just like a rare old wine, available only to those willing to pay?

Thoughts along this line remind me of the October evening in 2009 when my regular dining companions and I saw her and her husband at dinner at the Shangrila Hotel in the same 24th storey restaurant where we were eating too.

Given the money she earns — on just one patient — she was obviously there as a regular diner while we were there for a rare treat. No wonder we bitched over Evian water and $120+++ for five canned lichi martinis!

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26 thoughts on “What Susan Lim’s fees mean

  1. I am sorry. So, going by your logic of free market then $250 million instead of $25 million would be fine as well? We are not talking about a Van Gogh painting here, right?

  2. No need 2 b sorry, BABO! Absolutely. ./. willing buyer n seller. As there’s only one VG, there’s also only one Susan Lim. I don’t see any problem unless there’s a gi-normous doctor shortage and she won’t operate unless paid $XXXm. Geddit? 😀

  3. The fact that even super-rich Bruneian royalty needs to seek
    a discount shows there her fees are definitely not right.
    $24 mil for cancer treatment when the patient still eventually died,is more than enough to build and staff a no-frill hospital
    in a small town.

  4. Hi Jack Tan! Y do pple focus on the large numbers and not on the real issue at hand? Which is: had Dr Lim a right to charge the fees she did? Also, note tt no doctor however much or little they charge can guarantee that a patient won’t die, so that point is, to my mind, completely irrelevant.

    What I’m truly saddened by is that so many people read this particular post and two — so far — actually commented on it.

    How come no one is indignant when more than 100 oldies who could least afford to be robbed were robbed by one serial thief — and the sentence the thief received was so manifestly inadequate?

    I wrote about it in the post immediately b4 this, but no one shared my view or probably didn’t even read it!

    Sure the thief got away with just $330K whereas Dr Lim’s bills were $24 million, money which incidentally she still hasn’t been paid, K?

    Lastly, I don’t know Dr Lim from a bar of soap, just in case some who chance upon this post imagine I’m speaking up for her. Actually, I’m neither speaking up for or against her. Just sharing some thoughts her case has provoked, that’s all.

  5. To me, Dr Lim has means tested her client/patient and priced her services according to their ability to pay. Anything wrong with that? Definitely. Its like a hawker charging different price for the same plate of chicken rice. If he sees a millionaire driving up in a Merc, he charges $10 for a plate. The next in queue is a regular guy, he charges his usual $3. Isn’t that profiteering?

  6. My father is a man and my mother is a woman. Maybe this is why they call Motherhood statements.
    What is justice ? What then is fair reward and fair punishment ? Everyone can comment what is fair or unfair. But the official decision makers are left to the judge and the supreme being. In the case of Dr Lim, the publicity of the case sure helps to open the eyes of other Dr rendering special service to VVIPs especially the Brunei Royal Family. The amount charged even if halved makes everyone including top civil servants and political leaders envious. Had it been say 5m when normal cost are like 2m, then maybe it sounded reasonable if one has to drop everything and focus on just one patient. Given that there had been a contract, the issue becomes what is the stated cost in that contract ? It depends on the fine print and whether any amount is stated. What did the agreement amount to ? Treatment at all costs ? There could be some amount of greed and overcharging, but we don’t know the specifics. And without any service benchmark, the difficulty would be what is reasonable for “on the beck and call” type of medical service. What we layman deem as reasonable might not be a fair judgement given the lack of visibility into the contractual details. The press plays a strong role in influencing opinion and Dr Lim ( someone I definitely do not know as well ) has been “judged” since everyone reads Straits Times and few read your blog. Like all ministers, including Minister Ng, they are doing what they do with a sacrifice. Sure, the envious majority like us cannot help admiring their salary, but being monitored 24×7 with no privacy is something not those with ministerial capability is willing to give up for. We should be thankful for the few who do.

  7. You are not exactly sitting on the fence. Justifying such actions on the concept of willing buyer/willing seller is shallow. The real world is not built on such narrow precepts if you haven’t noticed.

    Just imagine yourself on the receiving end of a very very large bill (which you can still pay). I don’t think you would be a ‘willing buyer’ anymore. Unless…..

  8. Unless wot BABO? One might bitch about a large bill (larger than one had expected to pay), but one still pays up like a duke, no? At least that’s wot happens in a restaurant.

    As for doctors, we always stick to state funded hospitals. Yes we pay A class rates and are occasionally surprised by the size of the bills; both on the up-tick and the down-tick.

    But we never complain when bill is larger than we thought it should be. Why? Bceause we could have gone to polyclinic first to ensure lower bills but we don’t.

    So what right have we to kick up a fuss? That’s what’s a willing buyer n willing seller by my definition.

  9. Uncle Keng: so gladwe are on the same side of this debate for a change. And no, we aren’t curry favoring Dr Lim either, I’m sure, unlike wot uncharitable n suspicious minds may be thinking.

    I know plenty of other doctors: there are at least three in the immediate family. N no, none of them are in private practice.

    Those BBQ’ing Dr Lim are barking up the wrong tree, IMHO. They better be honest n ask themselves y they can’t make similar big $ instead of cloaking their real motives with righteous indignation. Don’t think the House of Omar (?) need impoverished (?) S’porean champions for their medical bill cause. 😀

  10. Hi Fisherman! U wrote: “Its like a hawker charging different price for the same plate of chicken rice. If he sees a millionaire driving up in a Merc, he charges $10 for a plate. The next in queue is a regular guy, he charges his usual $3. Isn’t that profiteering?”

    I see nothing wrong with your scenario. If the guy in the Merc objects, he can always get his chik rice elsewhere.

    The sad thing is, in the real world, the guy in the Merc would likely be given extra bits of chik n allowed to jump the q to boot because the hawker wants to cultivate tt market; not the regular guys’ market. As my mother’s fav Chinese quote says: Every toast (as done with drinks; not bread from a toaster!) is to the rich man!”

    As for means testing: would u have a problem if Dr Lim similarly calibrates her bills to put her services within reach of the regular guy? If wot’s gt fr the small guy, y not also gt for the small guy? Never heard of Robin the Hood? LOL!

  11. If you subscribe to free market, pro-choice, caveat emptor and willing buyer/seller, and have narrow definitions on these principles, you are indeed barking up the wrong tree.

    All these concepts/principles come with regulations and restrictions which are man-made and developed over many years. Without such regulations and restrictions we would have today child labour markets, abortions at the 3rd trimester, unsafe cars/appliances and no consumer protections.

    As far as I know, willing buyer/seller principle is employed in valuation of properties/assets (as opposed say to a forced sale valuation basis). To use this principle for the provision of a service is to me self-serving and wrong.

  12. Haha Uncle/Auntie BABO: talk about narrow definitions n falling into the same yourself!!!

    Surely u aren’t suggesting Dr Lim ain’t a qualified doctor/surgeon?

    Also, willing buyer/seller needn’t be restricted to property transactions. Even if by law there’s such a restirction — and unless u cite me the chapter n verse of that law — I belong to the happy group of laymen who use that term to mean tt no one has put a gun to the buyer (the service/goods receiver) or the seller (the service/goods provider) to effect a particular transaction.

    If one were to extend the jargons further, I would say that Dr Lim’s clients (the patient and her backers) belong to the “sophisticated” category of medical service buyers.

    Finally, Uncle/Auntie BABO, I’ve no personal or professional interest in this. Can you swear to the same? ^————-^

  13. Would support the comments of author here.

    Willing buyer/willing seller.
    Am aware of the caliberated billing in almost all good surgeons cases especially this particular case who has done pro bono and other charitable works since start of career.

    To be blunt, i thought the amounts are within reason, considering she was practically the on call physician, hence disrupting her other services.

    Further, this is a contractual dispute on fees and not a medical misconduct dispute.

    Regards

  14. The point is clear. Using any concept and re-defining it to suit one’s arguments is wrong and self-serving.

    But, we see this too often in Singapore. And, that’s the problem.

  15. Touche! Dat goes for u too dear Uncle/Auntie BABO.

    Unless u ain’t S’porean or human! Do have a laughing good week end. 😆

  16. I agree that this issue is in a bit of a grey area, but focusing completely on the willing buy/willing seller mindset does open the door to some very ethically ambiguous situations, something that sticking with that mindset will find very hard to resolve.

    Should assisted suicide be legal? Guns and drugs? If I sell you a poisoned apple, will I be legally liable if you die because you willingly bought it without asking? Don’t ask, don’t tell right?

    Morality doesn’t have any place in the willing buyer/willing seller mindset. Come to think of it, without morality, there’s no obligation to abide by the hippocratic oath 😛

    To say whether there’s anything wrong with what Susan Lim did, we’d have to know a lot more about how she came to those charges, information which we unfortunately do not have access to.

    P.S. auntielucia, don’t attack BABO so personally for goodness sake. Questioning his motivations is unfounded.

  17. Dear Chak, I’ve a friend who also goes by the nik of Cheechak altho hers is Chichak, and she uses hm too!

    1) BABO: I only get personal when a visitor gets personal with me. U go n read this person’s comments n tell me if it ain’t personal.

    2) Poison apple: far fetched analogy lah! Only Cinders step-mum n psychopaths will sell poison apples, so there’s no relevance to willing seller/willing buyer concept.

    3) Most, if not all, instances of the concept means the seller has self-interest to maintain market share or not to be sued for wrongful rep or is regulated or all of these. As for the buyer, it’s assumed there’s some modicum of knowledge, sanity etc..relating to the service/goods/asset to be purchaaed.

    3)Frankly I’m getting rather tired of this SL topuc. I’ll allow one more comment on this and my response to it; after which I’ll close the topic.

  18. well BABO,

    you said, ‘Just imagine yourself on the receiving end of a very very large bill (which you can still pay). I don’t think you would be a ‘willing buyer’ anymore. Unless…..’

    i believe it was reported that susan lim herself discussed the bill of 24.5m with the patient and her family and they had agreed to pay it. shows that they did WERE willing buyers from the beginning and backed out. if they thought it was too expensive why did they agree to the treatment from the beginning?

  19. Thanks for your comments Quirky! It’s easy to say what I would do in theory; it may be another story another if I were in her shoes. That’s the difficult part and I won’t even try!

  20. I think the point here is that they actually paid her bills for nearly five-years without a fuss. If they had issues with her bill, why didn’t they object to the bills earlier on?

    The fact is, the doctor did do work and has not been paid. Wonder why nobody seems terribly upset by the way a government can tell foreign enteties not to pay the Singaporeans they have dealings with………

  21. i agree with the author. willing seller and willing buyer.
    if you go hawker buy a pack of rice and you the seller tell you $5 for a pack of chicken rice. you can complaint to him it’s expensive and he can say that’s his price for a pack of chicken rice. if you don’t like you can go other stall to buy. i’m sure all hawker will reply that to you. THEY WILL SAY I DON’T WANT TO SELL YOU EVEN IF THE CHICKEN RICE IS READY TO SERVE YOU.

  22. Diane Ong: I think u super presumptuous. I’m not related to Dr Lim at all. Don’t even know her except by sight. And I don’t think those who agree she has a right to charge what she charged are related too.

    Otherwise those who r against the charges must be related to the Brunei Sultan?

    What nonsensical reasoning 😆

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