The future of medicine from the standpoint of the practising paediatrician.

* Emeritus Professor, National University of Singapore Senior Professorial Fellow, National University of Singapore Consultant Paediatrician, National University Hospital Consultant Paediatrician, Paediatric Clinic, Thomson Medical Centre Consultant, Thomson Prenatal Centre † Delivered at the 9th ASEAN Paediatric Federation Conference, 9 July 1998. From the time of recorded history of medicine, the doctor whether he be the ancient healer or the modern medical practitioner, the doctor had practised the art and science, on the basis of curing the patient when he has an illness. The doctor is sought out when the patient is ill. The so-called Hippocratic Oath refers to the codes the doctor should abide by when he practises his vocation,1 in such a manner that is honourable and that he should in no way harm his patient. This behaviour of the doctor towards his ill patient is further strengthened by numerous extensions to the ‘original’ Hippocratic oath through the ages till the present day to bring the oath to deal with changing social times. It emphasises the relationship between the doctor and the ill human being, i.e. the patient. Therefore, the doctor ’waits’ till the human being becomes diseased, before he practises his art. His job is done when he cures the patient, or when the patient succumbs as a result of the disease, as not all diseases are curable. Gradually, doctors came to realise that instead of waiting for the disease to affect their patients, it was often possible to prevent diseases in human beings, the classic example being Jenner’s observation that vaccination with cowpox could prevent human smallpox. Smallpox vaccination is so successful that it has been eliminated as an infectious disease throughout the world, so that smallpox vaccination is no longer practised as there is no smallpox to deal with. When smallpox was rife, there was (and still is) no treatment for smallpox so that prevention of smallpox is an example of a true medical triumph. The new generation of human beings, being born after the eradication of smallpox, cannot appreciate this medical triumph as he does not experience the illness. He does not seek out his doctor for management of smallpox as his parents, grandparents and great grandparents did. When the latter survived, they were grateful to their doctors, and of course, they willingly paid their fees for the services of their doctors. They had experienced smallpox and they can compare the situation previously and now, and appreciate what vaccination had achieved. The present generation cannot as they had not seen or experienced smallpox. I would like to refer this phenomenon of experience and appreciation as the syndrome of experience-appreciation (or SEA).