At the Heart of All We Do

08 Apr 2011

By Health Minister Khaw Boon Wan

Venue: College of Medicine Building

During the recent Budget Debate in Parliament, I outlined our Ministry’s plan for the next 5 years. Briefly, we will (1) Build a general hospital in every region, (2) Match the best in the world in health outcomes, (3) Redevelop our polyclinics, (4) Transform our long term care, (5) Get Singaporeans to stay healthy, (6) Involve the community on healthcare activities, and (7) Keep healthcare services affordable.

2. This will build upon the good progress that we have gained in the past 5 years. If we stay the course, I am confident we will make even more progress in the next 5 years.

3. Your theme for this conference: “Frontiers of Medicine: Advancing Patient Care, Education and Research” underpins your ambition to turn the Outram Campus into an academic medical centre. To do so, you need an effective strategy that delivers concrete outcomes.

4. I note your many recent achievements – such as performing Singapore’s first dual-kidney transplant using kidneys from a deceased elderly donor and being the first hospital in Asia to achieve Magnet® status, placing SGH among the top five percent of hospitals in the world. I also look forward to the contributions of your clinician scientists on improving clinical outcomes for conditions ranging from out of hospital cardiac arrest to liver cancers and leukemias. These are newsy exciting stuff, putting us at the forefront of medicine and research.

5. However, as we pursue medical excellence, it is useful to also remind ourselves of what our patients need and expect of us. When patients come to us, they just want clear answers to two questions. What is wrong with me? What can you do to return me to health?

6. Our job is to find the right answers and act on them, with minimum hassle to the patients, and in a way that is affordable to all Singaporeans. For most patients what they need is not necessarily the latest technology, or cutting edge research. These are important enablers but most importantly patients want objective sound advice and the lowest-cost option that delivers results. If they were our loved ones, how would our treatment be? We need to deliver on what your hospital tagline says “Patients: At the heart of all we do”. Our promise to Singaporeans is that we will live up to their expectation.

7. Over the last 5 years, we have done a lot to strengthen our healthcare system to deliver on this promise. This has required us to acknowledge several medical truths.

8. First, most human illnesses are fairly routine straightforward stuff. Once diagnosed correctly, treatment is well established and can be done competently in a regional general hospital. There is no need for such patients to come to an academic medical centre with its high-cost, high-tech sophistication.

9. That is why we are pushing regional general hospital development. Within the next few years, we will have a good general hospital within each major region. Good hospital care for the bulk of the patients will be accessible within 30 minutes.

10. Second, we will do more to help Singaporeans not yet sick to stay healthy. Every year, some 10% of Singaporeans fall sick and turn up at our door. We will serve them. But we must also serve the other 90% who are not yet sick, though they may be living with a chronic disease, like diabetes or high blood pressure. We need to help them manage their chronic diseases so that hopefully complications never arise. This requires good care in the community, outside of hospitals. This is low-tech and low-cost, but is probably the more important component of any good healthcare system.

11. It is about healthy lifestyle, social engagement, wellness programmes that Minister Lim Boon Heng’s committee is actively rolling out in the estates through People’s Association. We must actively support them, participating in health education talks, health screening, counseling, and follow-up care for the high-risk groups.

12. Third, we are all mortals. When the limits of medical science have been reached, we should focus on palliative care, relieve pain, minimize suffering, and help bring closure for the family. We must actively facilitate good dignified end-of-life care. We must not engage in mindless futile pursuit, misleading patients and families on unrealistic goals.

13. Hence, even as you pursue high tech sophistication in Outram Campus, bear in mind that your more important responsibility often lies outside of the campus. The more you can help Singaporeans stay well, so that they do not have to come into the campus for treatment, the greater is your contribution to Singaporeans’ health.

14. Your board and medical leadership have accepted this responsibility. That is why when Venerable Kuan Yan of Bright Vision Hospital asked for help last year, you came forward readily to help stabilise the community hospital, and put it back on track. That is also why as we seek to plan a new general hospital in Sengkang, you again came forward to assemble a team to plan this project. This is a testament to the breadth and depth of talent within the SingHealth Cluster. This is also a testament to your leadership’s wisdom.

15. Let me take this opportunity to thank you for providing this leadership. As the oldest and the most established medical institution in Singapore, you provide an important anchor to our healthcare system. Singaporean patients look to you for solutions when they are desperate for one. Singaporean patients look to you for an objective opinion when confronted with conflicting and confusing advice. Aspiring doctors and nurses look to you for excellent training and career opportunities.

16. I will add one point. Singaporeans also look to you for the highest standard of medical ethics that they expect Singaporean doctors to display. You provide the moral compass and the ethical benchmark against which the other providers could measure. Through your conduct, you demonstrate to the public that medicine is a calling, a noble calling; that medicine is not a business. There is no place for exploitation in medicine.

17. Over at the Novena campus, we are starting a third medical school, in partnership with the Imperial College of London. When asked recently on how they aim to create doctors that put their patients first, Professor Martyn Partridge, Senior Vice-Dean of the new school, said:

18. "What we need to ask is, would the experience with the doctor be the same if the patient was his mother … ? If we can't say yes with the doctors we produce, then we have failed". He went on to say:"Not only should they understand the science of disease and the appropriate investigations, but also they must have a sense of partnership with the patient, and always be thinking about how the healthcare service is organised to make it most convenient and comfortable for him or her." Prof Partridge believes that choosing the right students with soft skills on top of intellectual capability will mean fewer headaches later on. He explained that studies have shown that doctors with poor bedside manners are far more likely to generate patient complaints. When they show empathy, patients are more likely to stick to their treatment plans.

19. I fully endorse Prof Patridge’s prescription. This will put service firmly in medicine, producing doctors people want to be treated by.

20. This is of course not a new revelation. Our two medical schools have always strived to do the same. In our midst, we have many such doctors who have put patients at the heart of all they do. Just last week, a patient’s son copied an email to me about his mother’s recent experience as a Class B2 patient in a public hospital. It was a heart-warming letter. Let me read a shortened version of it to you, with names deleted to preserve patient confidentiality:

“My mum, aged 89 had a fall … and was rushed to (hospital). She was warded … and subsequently diagnosed with a … hip fracture….

"The following day, I met up with Dr M. … He was succinct in explaining to me my mum's medical condition. He thoroughly explained to me the various medical care approaches and the possible risks that could arise. He even forewarned me that there is a possibility that my mum may collapse and fall into a state of unconsciousness. We went through in detail the various treatment options. I choose a "passive approach", not wanting to traumatise or hurt my mum further should she needs to be revived. All this while Dr M was cool, calm and very caring. … I had a shock when immediately after the discussion, my mum went into a state of unconsciousness. The doctors then rushed in to try their best to revive my mum …. Moments later Dr. M told me to contact all my family members as my mum did not respond well to their life saving efforts … . Throughout the night, with the oxygen mask and the medication …, and later a blood transfusion, my mum survived the ordeal.

"The next morning, they suspected that there is a blood clot near the lung. Soon my mum was seen by Dr. P and his team of dedicated doctors. During the next nine days, my mum steadily recovered. It is indeed a miracle to see her getting back her strength and life. She eventually could swallow liquid food. She even responded well to her physiotherapy sessions. I am indeed indebted to Consultant Dr P and his excellent team of doctors. Even on Sunday, he comes back to visit his patients. He listens, shares his wisdom and knowledge and is decisive. He stressed many a times, that the minute my mum is strong enough he will discharge her to recover at home. Follow-up Home Care is best for my mum, he recommended. Dr. P seems to have read my mum's mind well for she fears staying in hospital and for being left alone. Dr R, the Registrar, another dedicated and a professional doctor impressed me. Patiently and with a hand drawn diagram, he explained and updated me on my mum's medical condition. He thoroughly explained the medication needed for my mum and assured me that they will follow-up closely to monitor her. I am also impressed with House Officer T. She is very dedicated, often skipping lunch just to tend to her patients. She has a soft caring approach too. She is very accomodative and responsive to patient's needs. As for the Nursing Care, I must single out Nurse Manager S and her dedicated team of nurses. My family of 15 brothers and sisters were very demanding. Nonetheless, the understanding and patience shown to my family members were very touching and much appreciated. This recent experience not only reinforced my belief and conviction in your doctors but also amplified the excellent health care that we in Singapore enjoy.”

21. This was the actual experience of a subsidized Class B2 patient who went through a lot of trauma. But our dedicated team of doctors, from consultants to house officers, nurses and therapists put her at the heart of all that they did, and made the difference to her outcome. The team made me proud as the Health Minister.

22. When I was a patient of yours last year, many of my fellow patients from Class A to Class C, shared similar heart-warming experiences with me. They cheered me considerably. While we are not perfect, our public hospitals have clearly touched many lives.

23. As we discuss the science of medical excellence, let’s be inspired by these stories and be reminded of the art of empathy, compassion and kindness. Let’s continue to touch lives and put patients at the heart of what we do. I wish you a fruitful conference.