By Ong Chooi Peng and Tan See Leng
We live in an increasingly complex and converging society. Our patients are more keenly aware of their conditions, their needs and their rights. As a fraternity, the earlier we recognize this and the more we work together to improve our outreach to them, the better we will be able to manage a more diverse and complex array of issues, with better clinical outcomes and service excellence for our patients.
Doing Good and Beyond
I sat in on a consultation once. The patient was an elderly retiree with an acute cough that he wished evaluated with an x’ray. The young doctor sent him for an x’ray that, not unexpectedly, turned out to be normal. He also had a knee pain from mild osteoarthritis that he wished assessment for by an orthopaedic surgeon. The young doctor obliged him with a referral. He requested a supply of NSAID* for his knee pain. The young doctor protested, mentioning adverse drug reactions., but the patient insisted and prevailed. He ended with a request for skin creams “for standby”. The young doctor, drained by then, prescribed whatever he desired.
How does one tread the fine line between good natured obligingness and unthinking acquiescence?
—–Dr Ong Chooi Peng
*NSAIDS are a class of painkillers that, although effective, come with a range of side effects that make them less suitable options for elderly patients.
Commentary
We practice and operate in a highly competitive and stressful environment. Patients are better informed and have more intricate requests than before. Payor-provider relationships vary vastly from the traditional patient-doctor compact. Social media feeds and threat of legal action compete with clinical practice guidelines to influence medical care.
How do we soldier on and do the best for our patients? Today’s primary care doctor needs more than updated knowledge and engagement in his professional community. He needs to build trust, painstakingly over time, with his colleagues and his patients. His patient base should be diversified to include different forms of care financing. And instead of resisting change, he needs to adapt to the new and innovate with it.
In the drawing, the towering figure could be the patient, his employer, or the insurer insisting on certain investigations or treatment. The doctor finds himself having to constantly choose whether or not to accede to demands with no clear medical indication, or with ambivalent medical justification, or worse – demands that put him in clear conflict with professional values and ethics.
For our healthcare system to be robust and sustainable, we need a durable tripartite relationship between doctor, patient, and payor that is built upon mutual respect and trust.
—-Dr Tan See Leng
Dr Ong Chooi Peng practices in a polyclinic and also in a community hospital. She counts it a blessing to have been part of Family Medicine in Singapore through a time of formation and growth.
Dr Tan See Leng spent some time in general practice following a stint in the public sector. Although he is now a full-time administrator, he remains deeply interested in the primary care delivery ecosystem (as at 2019).
The commentary and vignette were reproduced with permission from the book “Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore. Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures
