By Lee Kheng Hock
Many patients have an additional disease when they suffer from their ailments. The extra co-morbidity is fragmentation of care. Care fragmentation increases with increasing number of ailments, as care needs become more complex and require input from multiple providers.
The Tai-Chi of Care
Continuity of care is a universally accepted priority. We recognize that fragmented care can be ineffective and harmful. Following our precept to first do no harm, no one ever sets out to design a healthcare system that is intentionally fragmented or discontinuous. And yet unfortunately, the way we organise and fund healthcare can result in serious discontinuity.
We organise healthcare delivery according to organs and diseases. We physicians create our careers along similar silos. Professionally and financially, we are rewarded for providing care in parts.
Healthcare workers on the ground are often forced to cope with this part-by-part apportioning by behaving in ways that aggravate the situation. This is illustrated in the Tai- Chi of Care pictogram. The poor patient is caught in the centre of the whirlpool of the tai chi dance, kept away from the ideal of a medical home.
Can we really blame the system? We are the system.
—-A/Prof Lee Kheng Hock
Lee Kheng Hock was a general practitioner for ten years before he set up the first Family Medicine department in a hospital in Singapore. He currently works in a community hospital and is involved in undergraduate teaching, care integration, community-based medical education, and health services research. He is past president of the College and the current Chapter of Family Medicine Physicians chair at the Academy of Medicine.
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.
