In the last issue, our experts shared their insights on a neurosurgeon residency, the harmful effects of blood sugar spikes and demystified facts about infectious diseases.

In this first issue for 2023, experts from Duke-NUS as well as our academic medicine partner, SingHealth, are back to share their insights to your burning questions.

This time round, they are tackling questions on the qualities important in a doctor, the science behind sleep paralysis and what we can do to avoid heart failure.

We welcome all questions and will focus on those where our experts can provide the most meaningful answers. No question is too philosophical or technical or trivial, so please keep them coming!

Have a question? Send it in and it may be answered in the next issue of MEDICUS!


What is the most important quality a doctor must have?

What is the most important quality a doctor must have?

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A “good” doctor achieves the best possible outcomes for patients as well as the broader community (including family, of course!).  So, what single quality can I point to that makes a doctor “good”?  

The potential list of qualities is quite long: being authentic, broad-minded, calm, empathetic, humble, knowledgeable, non-judgemental, skilled, and so on. It does not include being funny or natty (though I wouldn’t deny that to a doctor if it makes their work more satisfying).

If I had to pick just one quality, it is curiosity.

But let me explain (as I often find myself saying – to the exasperation of my family and colleagues). 

If your doctor was not curious then medical school would have been an immense bore, merely an accumulation of facts. Clinical training would be a grind without relief, with patients serving as a collection of signs and symptoms and diseases. Having drudged through those many years, practice would be no better.

On the other hand, if your doctor were curious, training would have been a grand party (though tiring) and practice a marvellous opportunity. Your doctor would listen to what you have to say and be interested in what you say and what it means. They would not pre-judge knowing that, from a position of curiosity, there are often (always) surprises. And with the knowledge base of medicine changing at an immensely rapid pace, they would be keen to be up to date.  

And one more thing: the neuroscientists tell us that curiosity induces a virtuous cycle, promoting a sense of reward (of course, through dopamine), and continuous learning supports cognitive health.

So, from the quality of being curious, a doctor achieves all the other qualities that make a doctor good, and the joy that can make them great, even when they are old.

Professor David Matchar 
Duke-NUS Programme in Health Services and Systems Research
Duke University Professor of Medicine and Pathology

Over the years I have considered passion, empathy, compassion and diligence as critical qualities which a clinician should have. While they are certainly important, if I had to choose one, then I would say “balance”.

Balance—being able to balance passion, perfectionism and professionalism!

We all have our strengths and often these are the qualities that led us to pursue medicine. But we have to realise that at some point in time, these strengths can become a glass ceiling if left unchecked. Or worse, compromise our ability to provide the best care to patients.

For example, perfection and obsession with details are important qualities in preventing errors in the practice of medicine. However, extremes of this can result in a delayed transfer of our skills and knowledge to others within the team, affecting the timely provision of treatment plans and care. The same applies when advocating for patients. In our desire to push for the perfect treatment possible for the patient, instead of going with a “just enough” or “good enough” treatment, this intention to do good can sometimes result in more suffering instead of achieving the best outcome for the patient.

Passion and compassion are equally important qualities for clinicians. But again, extremes of these emotions can affect our mental health and lead to burnout, or conversely, we may develop a callousness as a means of self-protection.

Thus being able to balance between extremes is what I consider to be most important. And to achieve this, we as clinicians need to understand ourselves, reflect and actively seek good and honest feedback to grow professionally as well as personally. As we continue to develop this quality, we will also help create a better healthcare environment that provides the best care to patients.

Associate Professor Ong Biauw Chi
Duke-NUS Master Academic Clinician
SingHealth Duke-NUS Anaesthesiology and Perioperative Sciences Academic Clinical Programme
Senior Consultant, Anaesthesiologist, SingHealth
Group Chief Risk Officer, SingHealth

What is the science behind sleep paralysis?

What is the science behind sleep paralysis?

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Sleep paralysis can happen to anyone. Common triggers have been linked to and are not limited to habits and practices such as caffeine and alcohol intake, smoking, drugs, anxiety, poor sleep quality or irregular sleeping hours. Individuals with specific sleep disorders like narcolepsy, obstructive sleep apnoea or insomnia are also known to suffer from sleep paralysis.

Sleep paralysis happens when our muscles are not moving smoothly through the stages of sleep. During this process, a person’s eye movements and breathing remain unaltered, and their perception of the immediate environment is clear. So they may feel awake but unable to move. It can trigger a choking feeling or the sensation of pressure on the chest, which can at times, be terrifying.

Sleep paralysis usually occurs when a person is falling asleep or upon waking up, which is when the rapid eye movement stage of sleep occurs. The REM sleep stage is associated with vivid dreaming, if it does indeed occur. While we don’t currently know which the brain regions or networks are associated with sleep paralysis, the likely reason for sleep paralysis is muscles not moving in response to unwanted or even dangerous movements in a dream. Despite that, an individual suffering from sleep paralysis may still be able to open their eyes, as some studies have shown.

In the vast majority of sleep paralysis episodes (up to 90 per cent), patients are recorded as experiencing a great sense of fear. For example, the fear of having suffered a stroke or becoming permanently paralysed, which may or may not be accompanied by frightening dreams. This fear is not to be confused with existing fears of possible stroke or paralysis.

Clinical Associate Professor Ratnagopal Pavanni
SingHealth Duke-NUS Neuroscience Academic Clinical Programme
Senior Consultant, SingHealth Duke-NUS Sleep Centre

What are some steps people can actively take to avoid heart failure?

What are some steps people can actively take to avoid heart failure? 


Heart failure is a condition where the heart does not function adequately to meet the demands of the body, resulting in a person feeling easily tired and breathless. It happens when a weakened or stiff heart is unable to pump blood around the body effectively.

Although we now have a good understanding of the conditions that lead to heart failure, many of these are not preventable. They include genetically inherited diseases and unexpected adverse responses during pregnancy or to certain drugs. But for a significant number of patients, we are unable to identify a cause for heart failure.

Nevertheless, some of the more common causes of heart failure such as ischaemic heart disease (or IHD, a condition where the blood supply to the heart muscle is reduced) or hypertension (high blood pressure) are associated with modifiable risk factors that can be managed with the help of a physician.

For a start, regular exercise is encouraged—at least 150 minutes of minimally moderate intensity exercise every week. Eating a varied diet rich in fruits and vegetables, quitting smoking, and reducing our intake of alcohol are other lifestyle changes that we can adopt to reduce the risks. Individuals with hypertension should also limit their daily salt intake.

It is also important to go for regular health screening to check for pre-existing conditions that are risk factors for heart failure such as high blood pressure, diabetes and high cholesterol if you are above the age of 40, or earlier, if you have other associated health conditions for treatment and regular follow-up with your general practitioner, if needed.

Heart failure is a chronic condition requiring lifelong management. While the steps to keep tabs of the risk factors may seem difficult to achieve, they are far easier than living with the consequences of a weakened heart, so why not start today?

Clinical Associate Professor Chin Chee Tang
Academic Vice Chair (Faculty and Professional Development), SingHealth Duke-NUS Cardiovascular Sciences Academic Clinical Programme 
Senior Consultant, Department of Cardiology, National Heart Centre Singapore

Clinical Assistant Professor Audry Lee
SingHealth Duke-NUS Cardiovascular Sciences ACP
Consultant, Department of Cardiology, National Heart Centre Singapore

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