Never Too Old: Retirement would be 'boring', says 93-year-old cardiologist still working full-time

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Never Too Old: Retirement would be 'boring', says 93-year-old cardiologist still working full-time

What drives one of Singapore's pioneering heart specialists? In the first part of a series on elderly who choose to spend their golden years working, CNA speaks to Dr Charles Toh Chai Soon about his enduring love for medicine.

Never Too Old: Retirement would be 'boring', says 93-year-old cardiologist still working full-time

Dr Charles Toh Chai Soon, one of Singapore's pioneering cardiologists, at his clinic in Mount Elizabeth Hospital. 

28 Jan 2024 

SINGAPORE: The second most surprising thing about the clinic of eminent cardiologist, Dr Charles Toh Chai Soon, is a handwritten sign wrapped in plastic and stuck to the registration counter.

It reads, in block letters: CASH PAYMENT ONLY. 

Its existence feels antithetical to Singapore’s digital push, not least since the clinic is in Mount Elizabeth Hospital – a private hospital in Orchard Road – where it would be reasonable to assume patients coming to consult a heart specialist expect to pay by card.  

The sign appears less out of place, however, next to the floor-to-ceiling filing cabinets that store patients’ medical records. The records are handwritten, as are the labels on the drawers – a quirk that the receptionist endearingly calls “old school”, like her boss.   

The most surprising thing about the Charles Toh Clinic is that its founder, Dr Toh, seven years shy of turning a century old, is still working full-time.

As a cardiologist, he is a consultant who specialises in the treatment and diagnosis of heart diseases. He is not a cardiac surgeon and does not perform operations. If he were a surgeon, he noted, he would have had to stop working a long time ago.

And god forbid anyone suggest that he take a break.

“Can you imagine doing nothing at all? Very boring,” he said when asked about retirement plans, repeatedly brushing off the prospect of calling it a day.

Dr Toh's desk is stacked with medical literature and biographies, among other reading material. 

LOVE FOR ROUTINE 

Having turned 93 last September, Dr Toh has mastered the science of sticking to a routine.

Every morning, he leaves home at 8am, arriving at work by 8.30am. He settles into his day by visiting his patients in the wards. If the wards are “quiet”, he heads to the doctors' lounge on the second floor to have breakfast before his clinic opens at 9am. 

Come lunchtime, which is usually from 12.30pm to 2pm, he may take a teleconference call or spend his break in the doctors' lounge with other physicians.

When he feels like it, he goes to Lucky Plaza or Paragon shopping centre situated near the hospital to “jalan jalan” (take a walk), he said. 

His afternoon routine mirrors his morning’s, except for Saturdays, where he only works half a day until 1pm. On weekdays, the clinic closes at 5pm. Before leaving the hospital, he usually visits his patients in the wards again. 

Occasionally, he treats himself to a foot massage at Lucky Plaza before going home.

Dr Toh during his lunch break with two colleagues in the doctors' lounge at Mount Elizabeth Hospital. 

Understanding Dr Toh’s adherence to his routine is key to understanding the medical pioneer, who is credited for much of what cardiology is today in Singapore.

But he summarises his character simply: “Fairly disciplined” and “quite regimented in my way of life”.  

His biography published by World Scientific Publishing, titled Heart to Heart, provides a more detailed explanation. In a chapter written by his second son, Dr Toh Han Chong, deputy CEO at the National Cancer Centre, the younger Dr Toh said his father has “an ascetic self-discipline, and is very punctual and precise”.

For instance, his father walks the dog in the evening at a particular time, the 60-year-old wrote, “and one can almost set one’s watch to when he starts doing this”. 

His father is also “very fixed in his habits”, the younger Dr Toh elaborated in person. “He always plays golf on Sunday, and if it starts raining, he gets really upset because it breaks that cycle.”

The nonagenarian's commitment to stick to the course is also reflected in his sparing wants. He is “simple in his tastes and lifestyle” due to deep Japanese influence. During World War II, he was enrolled in a Japanese school in Ipoh, Malaysia, where he was born. 

“Even till today, his lunch is usually a simple bento box,” wrote the younger Dr Toh. And in any Italian restaurant, his father would “almost always order spaghetti bolognese or carbonara”. 

Dr Toh writes a prescription in his office. 

Dr Toh records his appointments and other notes in a little notebook. 

The older Dr Toh’s methodical nature also underpins his attraction to cardiology, a branch of internal medicine. The study of the heart is “almost mathematical”, he stated in his book.  

While pursuing his postgraduate studies in the UK during the late 1950s, the young doctor chose to specialise in cardiology because it is based on “very exact parameters, with logical conclusions based on a fixed set of clinical assessment tests and investigations”. 

Cardiology requires “you listen to the heartbeat and check the pulse”, he told CNA. “You calculate this, you calculate that, you do the ECGs (electrocardiogram) and so forth.”

A PEOPLE PERSON AT HEART    

After moving to Singapore in 1960, Dr Toh worked as a junior consultant at the Singapore General Hospital’s (SGH) Department of Clinical Medicine. In his time at SGH, he was involved in developing its Department of Cardiology. 

At the same time, Dr Toh was a lecturer; SGH was the main teaching hospital in the country then. In class, the cardiologist had a reputation for being fierce and wouldn’t hesitate to tell off students if they examined the patient wrongly. 

One of his students, Dr Lee Wei Ling, the daughter of founding Prime Minister Lee Kuan Yew, “refused to be in my ward”, he recalled laughing. “Then her father asked why. She told her father, ‘I’m too scared of him.’”

There was no shortage of prominent figures in Dr Toh’s storied career, according to his biography, including some who were his patients. In 1968, for example, he was called to help care for Singapore’s first President, the late Yusof Ishak, who had been hospitalised for an irregular heartbeat. 

And in his office today – alongside medical journals and magazines, Southeast Asian art and photos of his grandchildren – stand a couple of photos with his late friend and former President S R Nathan, whom Dr Toh remembers as a “very nice” man.

Dr Toh talks to his clinic assistant about a patient case.

Dr Toh chats with the receptionists at his clinic - one of many interactions he enjoys throughout a regular day. 

Despite his illustrious achievements, Dr Toh is perhaps living his best life in his golden years. Having forged a path for younger cardiologists and medical professionals to enjoy the fruits of his labour, he can now focus on what he loves most: Meeting people. 

On a 10-minute stroll around his usual haunts in the hospital, he morphs into a tour guide, sharing the history of certain clinics and their specialists. Just before heading off for the day to meet a friend at Lucky Plaza, he runs into two young Malaysian workers from another clinic at the lift lobby – who light up as though they've met their grandfather – and doles out praise for Malaysians. 

And in his office, a computer is noticeably missing from his desk. It would be a “distraction”, preventing him from giving undivided attention to his patient, Dr Toh explained matter-of-factly.

“I enjoy medicine. It’s so interesting because you’re seeing different people all the time. And of course, when you come to the hospital, you see your colleagues. You have tea and lunch together,” he added. 

“As you get older, the volume of your patients goes down; it’s only natural. But I can’t imagine doing nothing at home. There are a lot of people who look forward to retirement, but once they retire, they find they are so bored.” 

Dr Toh's wife died over a decade ago and his three children all have flourishing careers and families of their own, so he has even more reason to continue working.

Singapore's retirement age is “still quite young”, he said. “There are many people after retirement who still go into some kind of business with their colleagues or sit on some director board.” 

Dr Toh’s sprawling resume in his biography lists around 15 directorship or membership positions on statutory boards from 1968. This includes being chairman of the National Medical Research Council from 1994 to 2000 and deputy chairman of the Public Service Commission from 2010 to 2013.

“Dad was invited to join politics, but he said no because he enjoys seeing patients," the younger Dr Toh shared. 

Dr Toh calls a patient to set up an appointment. 

ACTIVE IN ALL WAYS 

While Dr Toh believes one should remain physically and mentally active at all ages, he acknowledged that in some professions, there are “limitations” to continue working at his age. 

For instance, a dentist or surgeon depends heavily on their hands and technical skills, making it unlikely that they can remain in practice in their 90s. 

“Internal medicine is different because you’re giving an opinion; you’re not operating on people. Different professions have different demands, and in the end, expectations cannot be the same,” he said. 

How, then, does one land a career fulfilling enough to work decades beyond the typical retirement age without burning out? There are only two things that should matter to young people, advised Dr Toh. 

Their interest and their strength. 

There is “no point” in having one without the other, he said. 

“In the first place, you must choose the right career. When you choose one that isn’t your top choice, you may burn out earlier. The second point is, in certain careers, you have no choice (but to retire at a certain age).

“Of course, you may not think about all these things when you’re young … You only think about what you’re interested in.” 

The problem, however, is that “as some people age, their mental abilities go down”, noted Dr Toh. If that happens with physicians, “it’s not easy to practise” as they could prescribe the wrong medication. 

“Your mind has to be still intact – but to keep your mind intact is not the easiest thing to do.” 

Dr Toh walks to Lucky Plaza from Mount Elizabeth Hospital to meet a friend after work.

But Dr Toh’s mind isn’t merely intact enough to continue practising. He also takes pride in having “wider interests” than his profession – a necessity, he believes, for a long and fulfilling life. 

“I read a lot about Southeast Asian cultures and history … and I love music. Music is one of my great loves. There is also some interesting biological evidence that listening to music is good for the brain. It keeps the mind going,” he said.

“Of course, being in touch with people is important too … having that interaction. Watching TV is too passive for me.” 

Asked what he would like to be remembered for after his death, Dr Toh replied with a twinkle in his eye: “For leading a fulfilling, complete life.” 

Towards the end of an hour-long chat, he gets restless – an extra spring in his step gives him away. He quickly but politely says his goodbyes before zipping off to his next appointment, for there is still more to do and much to live for.

Lifelong Dedication to Medicine – Interview with Dr Charles Toh

This is the full version of this article.

Dr Charles Toh graduated MBBS from Sydney Medical School in 1955. He is a Fellow of the Royal College of Physicians (London), the Royal Australasian College of Physicians, the American College of Cardiology and is also an International Fellow in Clinical Cardiology, American Heart Association. For his pioneering of cardiology, Dr Toh has been regarded by many as Singapore’s Father of Cardiology. SMA News Editor, Dr Tina Tan (TT), speaks with Dr Charles Toh (CT) on his lifelong experiences and learns about how his work and practice may have changed as he grew older.

TT: Hi Dr Toh, thank you for meeting with us today. In our October issue which looks into the topic of doctors and retirement, we want to find out what someone like you who has been practising for so long thinks about the topic. Such topics are very interesting to me as I am in geriatric psychiatry, even more so in light of our ageing population. I saw in the newspaper just the other day that 18% of our population are aged 65 years and above.

First of all, how did you come to start this practice here in Mount Elizabeth Medical Centre (MEMC)?

CT: Well, I left the University of Singapore in 1975. For the first five years, I worked in Plaza Singapura. There, I rented a room for about five years, and I moved over here in 1980. The MEMC was not open until 1979.

The reason I moved was because I have always believed that, medically speaking, one should be in the same geographical area as the hospital. That way, you get an emergency call and you can be down there in five minutes.

Imagine if you got an emergency call and you had to travel to Youngberg Memorial Hospital (more commonly referred to as Seventh-Day Adventist Hospital) along Upper Serangoon Road, how long it would have taken for you to get there?

TT: Yes, especially so for specialists who have to do urgent interventions in the middle of the night.

CT: So, when I was in Plaza Singapura, it was quite tough, because every morning, I would start work, by going to Mount Alvernia Hospital for a ward round. From Mount Alvernia Hospital, I would go to the Seventh-Day Adventist Hospital in Serangoon Road. And then in the afternoon, I would go to Gleneagles Hospital. I had to visit three hospitals in a day until Mount Elizabeth Hospital opened up.

40 years on, today

TT: That sounds very tiring indeed. And right now, what’s your typical workday like?

CT: Of course, I mean as you get older, the work volume will be less. When I started my clinic here in 1980, I was only one of three cardiologists here – the others being Dr Albert Wee and Dr Lim Chin Hock. Now, there are about 50 of us in MEMC.

TT: Wow, that is a huge increase. But is there now more work to go around?

CT: Yes. Of course, for my side, much of my workload has reduced as I get older. Patients-wise, some have passed away, and some may stop coming. Many Malaysians used to come over to Singapore for treatment; now Malaysian healthcare services are quite advanced and expanded, so many of them will receive medical treatment in Johor Bahru, Kuala Lumpur, Penang and even Kuching. A lot of Medanese patients will go to Penang now as it is so near and more affordable.

TT: I see, because it is closer to them.

CT: Yes, so there is no need to come here, unless the patient has a specific doctor to visit. And of course, many of my patients have aged and passed away. In fact, the healthcare capabilities of Indonesia itself have also improved. There are several good private and government healthcare centres in Jakarta and Surabaya, and to a lesser extent in Medan. But Indonesia is such a big country, with a population of more than 270 million people. So, it is not possible for them to service everybody quickly. That is why some still choose to come to Singapore for medical treatment.

The main foreign patients here in Singapore are still the Indonesians. Fewer Malaysians come here these days. I used to get people from Bangladesh as well, but now they go to Thailand because healthcare in Thailand is much cheaper. Their healthcare standards are good, and it is only about half the price here!

TT: Yes, even Singaporeans are going there.

CT: Yes. And for my side, as I grow older, I get fewer patients. I do not really mind it though. I accept it.

As such, I am not as busy as I used to be. Formerly, I used to start at 8 o’clock in the morning and did not finish till 7 o’clock in the evening. [laughs] Now I finish at 5 o’clock and can even go jalan jalan (Malay for walk or stroll) during lunch time.

TT: Well, you have come a long way to now enjoy that type of lifestyle. So, how has work challenged you differently now compared to last time, especially when it comes like physical and even mental challenges?

CT: Of course, in the early days, I was much busier simply because there were fewer cardiologists. I got night calls almost every night. I would have four or five patients in the wards. If anything urgent happened, they would call me, and I would have to go and conduct a visit, which was almost every evening, either at MEMC or other hospitals.

Now, I have fewer patients. I may have one or two inpatients now when I used to have five or six.

The facilities in the private sector have improved a lot as well. They now have positron emission tomography scans, CT scans, and all that. Physically though, it has not been that different for me. With the decreased workload, it has been very manageable, so I am less busy and stressed.

TT: Excellent! [laughs] A more specialty-specific question next: what are the conditions that you now see/manage that are different from last time?

CT: Well, cardiovascular-wise, we now see fewer cases of valvular disease. Twenty years ago, there was much more valvular disease and heart valve surgeries were much more common. These days, the concentration is on coronary artery disease. Procedure-wise, heart bypass surgeries are still going on, but balloon angioplasty has deferred and replaced quite a significant number of potential bypass surgery cases.

TT: What were the challenges you, or maybe your friends, had to overcome, in order to continue work past the official retirement age?

CT: I mean, dementia is the biggest factor. Once you have got dementia, you will have to give up practising. But I think, fortunately, being a physician is easier because we are not as dependent on technical skills. If you are a surgeon, it may be a bit harder to work after the age of 70. Although there are surgeons like Dr Tong Ming Chuan, who is still doing very well at the age of 75; in general, I would think that physicians are not as disadvantaged compared to surgeons.

TT: Out of curiosity, who is the oldest practising surgeon whom you have known of?

CT: In the old days, Dr Yeoh Ghim Seng was one of them, he was probably 70 years or older. Former president Dr Benjamin Sheares, from O&G, continued practising till he was about 75 years old. He delivered all three of my boys; Han Shih, Han Chong and Han Li were delivered by Dr Sheares in Gleneagles Hospital.

TT: What about physicians?

CT: Physicians can practise for longer. I am 92 years old.

TT: That’s great! You are truly a role model.

CT: It is helpful to stay slim, not get greedy or fat, avoid getting diabetes and avoid smoking. [laughs]

TT: Yes, that’s true. But genetics play a part too.

CT: Perhaps that is true. My mother passed away at about 85 years old, my father passed away at 75 years old. Of course, in those days, healthcare standards were poor in Malaysia.

TT: In those times, to be able to live up to 85 years old was considered quite a feat!

CT: True! My mother worked in her diamond jewellery business until she was 80 years old. My mother was a Nyonya from Penang. She married my father from Ipoh and continued her diamond business in Ipoh. I used to help her when I was a kid. She had even asked me to go to Antwerp to learn diamond-cutting, but I declined.

TT: Where did she get her diamonds from?

CT: Oh, she buys from the local Jews, the Flinters (UK) and Greenberg’s (UK). She buys diamonds from them, then design and set it up for sale. Sometimes, she would buy from the Nyonya in Penang their kerongsang (traditional Nyonya brooch) and such items. They would dig out the diamonds and reset them with new designs. Since I used to help her, I learnt a lot about diamonds as well. That was why she wanted to send me to Antwerp, where they did all the cutting and diamond trading. My father was a banker, he was the manager of Hong Kong Bank, Ipoh.

Retirement: yes or no?

TT: So, we have talked about surgeons and physicians, and how one set may have a shorter “shelf life”. As a physician then, what would you feel are the reasons for other doctors and also yourself as to why one would retire later versus earlier?

CT: My personal opinion is that you should not retire if you can continue with the work satisfactorily. There are a lot of people who are mistaken; they think, “Wow, I look forward to retiring.” But a while after they retire, they might find that they are constantly bored.

Personally, I kept up teaching in SGH until about twenty years ago. I used to give classes – tutorials – there once a week to medical students. But I remained active in Medical Boards like the Medical Research Council and the National Cancer Centre Research Fund.

TT: In my practice, I often see that when a husband retires and starts spending a lot of time at home with the wife, there is a period of adjustment and conflict. Especially if the man has to figure out what to do now that he’s no longer working.

CT: Yes, they have nothing to do so they nag at each other. People do not really think about this. But of course, unfortunately, in certain professions one has got no choice. For example, if you are a civil servant, it can be more challenging since the public service may not re-employ you.

If you are a surgeon requiring certain technical skills in your work, you may experience some difficulty after a certain age as well. But physicians are still alright, because you are using your brains only. You are a psychiatrist, right? You can go up to 103 even.

TT: Yes, but I do not know if I would work all the way till 103! I am sure you have friends who retired much earlier though, what were their motivations?

CT: Actually, there were many of them. They were very busy in the private sector, and they looked forward to having more time to themselves after retirement. What they did not realise was that having too much time suddenly can be really boring. By which time, it is too late; they cannot go back to their work once they have retired.

I miss some of my fellow senior doctors. Some of them have retired and refuse to work anymore. The younger doctors who start up new practices do not know who I am.

TT: Did you know of people who went through that experience where they retired and realised that it was not all rosy?

CT: Oh yes, of course. Some of them were very bored. I personally think that they may also develop dementia earlier.

TT: Inactivity and a lack of stimulation probably contributes to that. So then, what is your advice to someone who might be pondering when he/she should retire, and what should a doctor consider regarding retirement?

CT: I think, firstly, it depends on your profession. If you are a surgeon, I cannot tell you to not retire because your hands may not be as good as it was before. But if you are a psychiatrist or a cardiologist like me, you may not need to do procedures yourself. If you can get younger doctors to do them when needed, then you can stay on until you feel like you really cannot work anymore. I really do not think that we should have a set retirement age.

TT: In this case, do you have a retirement plan?

CT: [sighs] Yes, but I am a bit worried that if I were to retire, I would not know what to do with my time. I would be very bored, you see. I love music, and that can keep me going, I suppose. I can probably have a dog as well.

TT: Usually when doctors consider retirement, one thing that may be on their minds is “what happens to my patients?”

CT: That is not so difficult in my opinion. We pass on our patients to colleagues we know, although the patient may not accept it. After all, they may have made their own choices. Patients are all survivalists. Some of my patients have stopped seeing me because they think I am getting old, so they go to younger doctors, and you just have to accept it. But some of them who are used to you, they will stick with you.

TT: What about the practice? Your clinic space, staff, etc.

CT: When you retire, it cannot be helped. Staff may have to be let go, items and unit sold, etc. For instance, I actually had two units here. When my volume and workload reduced, I rented out the other unit space and kept this unit running. When I was very busy, say 20 years ago, I had four staff, but now I have two.

Lifetime of doctoring

TT: For your long-time patients, what is the length of the longest time you have known and attended to a patient?

CT: I think it may be 40 years or so. Some of these are patients that I have had since working in Singapore General Hospital (SGH).

TT: What conditions do they have, that they have been seeing you for 40 years?

CT: Well, many of them started with hypertension, then gradually they developed diabetes and coronary heart disease, then they have a bypass. And that then keeps them alive for another 20 years.

TT: There are GPs who have patients for a very, very long time, and they treat not just the patient’s chronic illness, but the patients’ families too. Do you have such experiences as well? Do you treat the entire family?

CT: Yes, sometimes siblings and families; they will recommend the doctor to one another.

TT: It can be a very different type of relationship with your patients then. When did you first start medical practice?

CT: I graduated in 1955. And then I spent three years working in Australia, followed by another three years in the UK. When I came back in 1959, the People’s Action Party had just come into power. I worked in SGH at that time and I stayed in the government quarters at Sepoy Line, behind the medical school.

TT: What was it like then?

CT: Very nice! It was relatively quiet in those days, in the sense that you did not see many heart surgeries; but the wards could be extremely crowded.

TT: Were there a lot more cases of infectious disease?

CT: Yes, many cases of pneumonia and dysentery. The old general wards in SGH used to take about 24 patients. However, during admission days, it could take up to 40, so we added centre beds along the corridors. Every morning, we would have to do a ward round and see all the patients! [laughs]

At that time, I came back as a lecturer – equivalent to being the registrar today – and there was one medical officer and one houseman working under me. Only three people, and we looked after 40 patients. And you still have the outpatients, from 11 o’clock till about 1 o’clock. We generally reserved our afternoons for teaching or meetings.

Most of the patients those days were C-class patients; they were very poor. There were many accidents and pneumonia cases in those days. At that time, there were very few private wards – the B and A class wards. When I was in Medical Unit 2, the private ward would be upstairs with about 30 beds.

TT: Were there any interesting encounters in the private ward?

CT: I will always remember President Yusof Ishak – he was admitted there in the 1960s. He came in with an atrial flutter, and we performed the first electric shock on him, a DC shock. I continued looking after President Ishak for his follow ups. On National Days, he would have to go to the Padang, and I would follow and sit at the back – in case anything went wrong.

At that time, it was very crowded in SGH, and then the 1964 race riots took place. It occurred at Geylang Serai and a lot of people were killed. The hospital was packed. Another incident I remember was when Malaysia had a riot in 1969 in Kuala Lumpur (KL). Quite a few of our doctors had moved over, because the new Faculty of Medicine in University of Malaya had started in 1962.

It was founded by Dr Thamboo John Danaraj. People like Dr Ong Siew Chay and others had gone over to the University of Malaya. However, after the riots, they wanted to leave Malaysia, and many considered heading to the US and other foreign countries. I was the Vice Dean of the Faculty of Medicine, University of Singapore at that time. I went over to KL and convinced them to return to Singapore, offering them university jobs. We brought back about five or six of them, mostly surgeons.

TT: How about on 9 August 1965 itself, when Lee Kuan Yew made his announcement that Singapore was leaving Malaysia? Were you at work?

CT: I had just returned from sabbatical leave and saw Mr Lee Kuan Yew giving his speech on television..

Outside of work

TT: How do you look after yourself, your health and body, while you continue practising?

CT: You mean apart from work? Well, I do a lot of things. For instance, I believe in frequent foot massages. I believe that there is some benefit to it. I go for foot massages twice a week, half an hour each session, especially since it is so convenient.

I also play golf on the weekends, and I walk with the doggies every day, so I keep active. I believe in having a good dog because it is somebody you can nag; you cannot nag your wife and family all the time. There is evidence that people who own pets are healthier.

I listen to music a lot as well. That is my other hobby. Even when I am driving, my music is on all the time. Every time I drive, I play my CDs – my favourite singer is Teresa Teng (Deng Lijun), as well as some English, French, Indonesian and Japanese music. I know many Japanese songs as I went to Japanese school as a little boy. I am also a strong supporter of the classics, Brahms, Beethoven, and all that.

When I was studying in Australia, I had a guardian who was very musically inclined. He was a great pianist, and he would take me to concerts once a week at the Sydney Concert Hall. Later on, when I went to the UK for my postgraduate, I would always go to London Festival Hall for concerts as well.

TT: Is there anything else that you think you do that keeps you sharp?

CT: To me, it has always been interaction and music. I read a lot as well, apart from medical texts. My habit is that I will read for about 45 minutes before going to bed.

TT: That is a very good practice indeed! Thank you for your time today, and for sharing your thoughts regarding doctors and our lifelong work in medicine, Dr Toh!