The Commencement of FM Academic Year 2005

25 Jun 2005

By Dr Mohamad Maliki Bin Osman, Parliamentary Secretary (Health)

Prof Cheong Pak Yean, President, College of Family Physician, Singapore

Prof Goh Lee Gan, Censor-in-Chief

Distinguished Guests

Ladies and Gentleman

Good afternoon

It gives me great pleasure to join all of you here today at the Commencement of Family Medicine Academic Year 2005. The term commencement is often used in different context in different countries. For example in the States, many Universities use the term commencement to mark the end of the University education for the graduates, suggesting that the graduates would embark on a new phase in their life outside the University.

Of course, many of you here may wish that you have already completed your training programme but, commencement today refers to the start of your academic year. What is similar, however, is that many of you here have made the decision to embark on this new phase of your professional career by taking up Family Medicine Training. And I congratulate you for making this decision.

DEVELOPMENT OF FAMILY MEDICINE AND FAMILY PHYSICIANS

The term "General Practice" has been in use since the early 19th century. However, Family Medicine as a specialty is relatively new, with the Americans introducing board certifications for Family Physicians only in the 1960s. Just like many other specialties, the need for Family Medicine as a specialty came about as a result of demand. Demand not only from the patients, but also from within the profession.

The 20th century saw the rapid development of medical science as well as sub-specialisation. While medical specialisation and sub-specialisation certainly brought about their benefits, they also carry the side effect of fragmentation of care. The result is that various doctors may know different systems or organ parts of the patients very well, but none have a very good overall picture, or know the patient as a person well.

Very often, we hear feedback from patients that after being referred to one specialist outpatient clinic for one problem, he ends up being further referred to 3 or 4 other specialists to look at different parts of the body. There is certainly a need for a more holistic approach in managing our patients.

On the disease front, with industrialisation and economic development, disease patterns shift from infectious diseases to chronic lifestyle conditions. These chronic diseases often share three common needs:

First, they require the significant participation on the part of the patients, often in lifestyle modifications. For example, in the management of high cholesterol, the patient needs to play his part and watch his diet. Medicine alone will not help. Even in taking medications, doctors need the cooperation of the patient. If the doctor prescribes the medicine but the patient does not take it, he will not get well. Thus participation of the patient in management is critical.

Second, chronic diseases require long term management and follow-up. For example, high blood pressure requires long term medications, regular follow-up and periodic adjustment of dosages.

Finally, the management of chronic diseases often require help from other members of the healthcare team or resources in the community. Diabetes for example requires regular eye screening and foot checks and some may even require more detailed dietary counselling by dieticians.

It is against such a backdrop of fragmentation of care and high prevalence of chronic diseases that sets the stage for the new generalists, the Family Physicians. The Family Physicians are well equipped with skills that can respond to these three needs.

For example, the family physician is a strong health advocate equipped with excellent counselling skills to understand the attitudes of his patient towards his illness and motivate the patient to modify his lifestyle. This personal relationship with the patient is also the key reason why the patient would continue to come back for follow-ups.

At the same time, the Family Physicians see not just the patient but often the family members as well. He thus has a good understanding of not just the family medical history, but also the family dynamics and how the patient can be best managed in the context of his family.

In addition to these softer skills, the Family Physician is also equipped with the knowledge of best evidence based practices and will effectively utilised the community resources in the best interest of his patient.

In short, instead of being the undifferentiated bulk of professionals defined by lack of special training, the new generalists, the Family Physicians have a well-differentiated role with a well-defined set of skills.

MINISTRY'S VISION

Since 2002, our Minister of Health has set "Managing Patients Holistically" as one of the 8 priorities for our Ministry. We hope that through promoting Family Medicine and getting Family Physicians to play an even greater role in our healthcare system, we will be able to achieve better outcomes for our patients and reach our vision of "One family doctor for every Singaporean."

In the last few decades, the role that Family Physicians play in the various healthcare systems around the world has become pivotal. Aging populations, and the rapid rising cost of hospitalisations around the world will further contribute to the rapid development of Family Medicine.

In Singapore, we still have a distance more to go to reach our vision. Currently, we have some 200 doctors with the Master of Medicine in Family Medicine. The Graduate Diploma of Family Medicine (GDFM) training programme has produced more than 100 graduates since its first examination three years ago. Together, this forms only an estimated 15% of primary care physicians.

This year, I understand, we have a record intake of 119 trainees for GDFM. However, to reach our vision of a family doctor for every Singaporean, we will need as many doctors trained in Family Medicine as possible. Ideally, we should work towards having all of our primary care physicians trained to deliver care at the level of a Family Physician.

ROLE OF COLLEGE AND THE PROFESSION

Training will not happen without the profession themselves being the provider and being committed to delivering quality training programmes. On this note, I am glad that the College of Family Physicians has played a key role not just in setting and maintaining the standards of training but has been forward thinking in responding to the needs of patients and the profession.

I am also happy to note that College have made continuous effort to improve the teaching programme by integrating e-learning into the programme this year so that even the busy doctor could learn in his spare time. The College's appointment of part-time Teaching Fellows also demonstrated your commitment to continually renew the core training curriculum and to ensure that the programme stays up-to-date and relevant to the challenges faced by Family Physicians of tomorrow.

It is really heartening to see the College and profession taking such an active role in the training. It must be obvious to many by now that it is no easy task to plan, coordinate and carry out these training programmes, especially for the record number of trainees this year.

Thus I hope all of you including the trainees, would also consider how you could one day play your part in helping to support the training programme, develop it further so that more younger doctors in the same fraternity can be trained. The profession, after all, is made up of each and every one of you.

However, if I may pose three challenges to the college in the medium to longer term future, with the hope of bringing Family Medicine to even greater heights.

First is the concept and role Family Physicians play, how do we encourage both the medical profession as well as the public to embrace this concept. How can we convince the medical profession, in particular the more senior GPs practising for a number of years to come forward and be trained so that they can take on an even larger role?  We have the infrastructure with GPs operating in all our housing estates, making them easily accessible to the Singaporeans.

Freedom of choice in our healthcare system is so deeply ingrained that very often patients may see a few doctors for the same condition. How can we convince the public of the value and benefits of having a regular Family Physician? These are certainly big challenges but if we are able to overcome these, it will certainly bring about benefit both to the public as well as to the profession.

Second, is the challenge of life long learning as a Family Physician. With more and more doctors taking up vocational training and thus starting at a higher baseline, how can we ensure that life long learning continues? And that the training is interesting and relevant to the practising Family Physicians and is able to further bring his skills up to the next level. At the same time, how do we ensure that these training programmes are not just training for the sake of training, but are relevant to the needs of the patients and society?

The third challenge is in the area of research. While Family Medicine research has already been well established in some counties overseas, it is an area that needs to be developed in Singapore.

How can our Family Physicians of tomorrow take part in meaningful research that will help shape the future of Family Practice here in Singapore? How can we challenge the inquiring minds of every Family Physician and interest them to take on research. How can the research questions raised in Family Practice be answered with the relevant research?

With research as a strong foundation, Family Medicine can certainly scale greater heights. Family Physicians can and will stand alongside their other specialist colleagues at the forefront of medical advances. Together, they will achieve the vision of Singapore being a medical hub.

Leaving on the note of these three challenges, may I congratulate the trainees again on your choice of Family Medicine as well as on the commencement of a new phase in your professional career. You have every reason to be proud of your choice. I wish you success and a fulfilling career as a Family Physician.  Thank you.