Speech by Mr Chan Heng Kee, Permenant Secretary (Health), at the Lee Kong Chian School of Medicine White Coat Ceremony, 16 August

Mr Lim Chuan Poh, Chairman of Lee Kong Chian School of Medicine Governing Board

Professor Bertil Andersson, President, Nanyang Technological University

Professor James Best, Dean, Lee Kong Chian School of Medicine

Professor Benjamin Ong,  Director of Medical services

Professor Philip Choo, Group Chief Executive Officer, National Healthcare Group

Professor Gavin Screaton, Dean of the Faculty of Medicine, Imperial College London

Distinguished Guests

Ladies and Gentlemen

1.     Good afternoon.  Let me begin by congratulating the new medical students who are with us at this year’s White Coat Ceremony.  I saw from the school’s FB post last week that you had been rehearsing, so you must be very excited today.  I would also like to extend a special welcome to parents of our students. You should feel proud that today, your children will be taking their rite of passage towards one of the most respected professions – medicine.

Evolving Healthcare System

2.     Today’s ceremony takes place within a changing healthcare landscape in Singapore.  On one hand, rising life expectancies, rapid population ageing and higher chronic disease burden are driving up demand and complexity in healthcare services.  On the other hand, rapid advances in science and technology are leading the way to new methods of detecting and treating diseases and also how we deliver care.

3.     We know where we want to head towards in Singapore. For healthcare in Singapore to remain accessible, affordable, of quality, and very importantly, also sustainable, we are shifting the centre of gravity of our healthcare system in three ways.

4.     First, we are moving beyond healthcare to health.  We need to do better and to do more in promoting and supporting healthy living and active ageing.  Help Singaporeans lead healthier lives, and prevent or delay the onset of diseases.

5.    Second, when it comes to patient care, we are moving beyond the hospital to the community.  We want to serve more patients in the community where they can receive more appropriate and effective care.  This means having a strong primary care sector and effective long term care sector.   Care options across different settings, from primary care to hospitals to long term care, need to be better linked up for more seamless patient flow.

6.     Third, we want to move beyond quality to value.  Advances in medical science and technology are exciting.  But they can also be costly. We need to make wise decisions on the care options and service models that are appropriate to Singaporeans needs. We need to choose tests, technologies, and treatments that are not just effective but also cost-effective.

Changing Practice of Medicine

7.    We can only be successful in making these shifts if the practice of medicine in Singapore also evolves.  Let me cite three areas where I believe changes are needed.  These in turn have significant bearing on the education and training of doctors in Singapore. 

Working to Provide Broader Integrated Care

8.      First, we need more doctors who are able to provide broader, integrated care.  In recent years, the practice of medicine has become very specialized; some critics would even say too organ or disease specific.  We will always need specialists, including those who can treat the rare conditions and carry out the most complex surgeries.  But as our population ages, we have an even greater need for physicians who are able to treat patients with several conditions and coordinate their care as one person.

9.      Family physicians will become an essential backbone to help patients manage chronic diseases holistically. We will also need more doctors in internal medicine, geriatric and palliative care.  Even amongst our specialists, we would need them to have broader competencies in these essential areas.

Working Across Care Settings

10.    Second, we will need more doctors who can work across physical boundaries and care settings. To move beyond treating diseases to promoting good health and preventing diseases.  And to enable patients to receive care and to recover at the most appropriate settings and not just the acute hospital. We will need more doctors to extend beyond the curative to the preventive and rehabilitative. 

11.    Many of you, when you start practising, will need to venture outside the hospital or clinic walls to the community, working hand in hand with other partners. Occasionally, you may even be needed at the patients’ residences to help them transit from hospital to home.

Working Across Teams & Professions

12.    Third, we will need doctors who can work across teams and professions.  However well-trained you are, you will have to work with colleagues and other healthcare professionals to provide effective care. One good example is the implementation of patient empanelment at our polyclinics, including the polyclinics at the National Healthcare Group. At our polyclinics today, patients with chronic diseases and complex conditions are matched to specific teams of doctors, nurses, allied healthcare professionals and a care coordinator who will work together with them over a prolong period to support their care, treatment and health. This is what we call team based care.

13.    Sometimes, the team may extend to non-healthcare professionals.  Examples include working with behavioural scientists to develop “nudges” to encourage desired patient behaviours, whether it is complying to a medication regime, doing rehab exercises or making lifestyle changes.  Given LKCMedicine’s parentage in NTU and Imperial College, I believe students here will have great opportunities to collaborate with engineers, computer scientists and technologists in the delivery of healthcare and medicine.

Role of Medical Schools in Supporting the Shifts

14.    In each of these shifts I have spoken about, medical schools have a crucial role to play.  They can facilitate these shifts by inculcating the right philosophy and mindsets early on in medical school education.  Their curriculum need to be designed to help students develop universal generalist skills, such as competencies in geriatric care, internal and rehabilitation medicine.  Here, I am pleased to read in the Straits Times last week that the deans of our three medical schools share the same view.  I assure you this was not coordinated!

15.    Medical schools should also provide their students with greater exposure to less-traditional settings, such as community hospitals, transitional and home care services and hospices and palliative providers. Schools can also create opportunities for medical students to understand better, interact more and collaborate with other healthcare as well as non-healthcare professionals.

16.    I am delighted to learn from Professor James Best that LKCMedicine is already embarking on such efforts.  I was intrigued by the Long-Term Patient Project, where over the next two years, students will each follow the course of a patient, often someone with complex medical and social needs.  What a wonderful opportunity to learn about illness in the context of the patient, the family, the home environment, the community, and the health professional care team. 

17.    I am also delighted to hear of LKC’s Family Medicine Interest Group for medical students who want to know more about Family Medicine as a career.  We need more family physicians who are family medicine trained. I am also gad to know that  some students here volunteer at the neighbouring Dover Park Hospice, which offers a valuable learning experience about holistic medical care at the end of life.  

Enduring Mission

18.    I would like to encourage LKCMedicine to take full advantage of its partnership with the National Healthcare Group, which I know share the views which I have just expressed, to bring about many more such initiatives.  I also hope that the students of LKCMedicine will support the broad shifts I have spoken about. And respond positively to the changes which the school will make. 

19.    As you navigate through your journey in healthcare – during your time in medical school and after graduation – it will be useful from time to time to reflect on why you aspired to become a doctor in the first place.  Here, I find LKC’s mission statement a good reminder, and I quote: “To equip you to become doctors who advance the science and practice of medicine for the good of humanity. The doctors you and I would like to have caring for us.”

20.    On that note, let me wish you the very best in the forthcoming new chapter in your lives.  Thank you.