Angry Doctor

Monday, May 22, 2006

"One Patient, One Physician"

Interesting news from the Ministry of Health.

18 Family Physician Clinics at polyclinics will be up and running by July

By Hasnita A Majid, Channel NewsAsia

SINGAPORE: By July, all 18 Family Physician Clinics that treat chronic illnesses will be up and running at polyclinics and the Health Ministry hopes that this will transform how the polyclinics operate.

Firstly by building up the doctor-patient relationship and secondly, through the appointment system to cut down on queues at the polyclinics.

Under the Family Physician Clinic, patients see the same doctors for their treatment in line with the Health Ministry's aim of having "One Patient, One Physician" concept.

"Every visit you'll get to see the same senior doctor, and once you build up a better rapport, the patient and the doctor and the whole team can actually work together to help the patient," said Dr Ruth Lim, Director of Sengkang Polyclinic.

This also means better compliance rate and the ability to empower patients with the necessary skills to manage their condition. As part of patient empowerment, those on the disease management programme at the Family Physician Clinics will be encouraged to get one of these Self-Care Toolkit - a kind of a health booklet where patients can jot down their blood pressure or sugar levels to chart their progress every step of the treatment.

Health Minister Khaw Boon Wan hopes these Clinics will help transform how polyclinics dispense their services in the long run.

Currently there are already 12 of these clinics up and running throughout the island.

"If you do things well and do things right, then 90% of patients ought to be by appointment, so why the need for all these long queues and unpredictability?" said Mr Khaw.

Earlier, he said there's much room for improvement in polyclinic care.

"I'm not proud of our polyclinics, honestly. You queue up one hour and suddenly you get that clinic open to you. You may be a repeat patient, but the next time you come, you see a completely different doctor, so it completely undermines this doctor-patient relationship which is so crucial," said Mr Khaw.

Besides polyclinics, general practitioners are also expected to help in the management of chronic illnesses as they form 80% of primary care.

The Singapore General Hospital has set up a new department, known as the Department of Family Medicine and Continuing Care, where doctors under the department will see patients for a few visits before referring them back to their GPs after a treatment has been mapped out.

"This is the way that we think we can improve the care so that as the patient move out of the hospital, to their primary care in the community, there is no break in the care and that means they can get the same level of care with the same family doctor, probably at a lower costs because there's no specialist fees and at the same time there's convenience," said Lee Kheng Hock, Head of Department of Family Medicine & Continuing Care, SGH.

The Ministry has said that it will allow Medisave withdrawal for outpatient treatment of chronic diseases.

angry doc does not have a Family Doctor, but he does have a 'Family Plumber'.

He was our family's plumber from since angry doc was a kid, and now, several address-changes later, he can still be counted on to help when angry doc's amateur attempts at rectifying any plumbing or electrical faults at home fail.

Typically, a detailed history of the presenting problem is taken over the phone, following which advice on remedial measures would be given, and an appointment for a 'house-call' would be made.

He never misses an appointment, can always be counted on to have all the requisite tools ready, and almost invariably has all the replacement parts required available.

I like to chat with him as he does his stuff. He would give a running commentary on what he was doing, explaining to me how things worked, where I went wrong in my attempts to fix the fault, and how I should repair the fault if the same thing happened again.

He is a craftsman and it's a joy to watch him work. It is clear that in the course of his work he combines extensive background knowledge with years of experience, and not a small amount of ingenuity when some improvisation is called for.

And when the time comes for him to leave, I not only get a feeling that a problem is solved, but that I would be better prepared to handle a similar problem should it occur again.

I am not sure if his charges are considered high by 'market rate', but I feel they are reasonable. In any case I do not have to ask for his help more than two or three times a year, and he makes enough to put his three children through university. None of his children are following in his foot-steps though, and sometimes I wonder whom I should turn to for help when he eventually retires.

Every family should have a Family Plumber like him.



  • will be interesting to see how this will work out. Staffing numbers is always a problem. You would need a significant number of senior PERMANENT doctors at each clinic in order to implement this. Do the MOs rotate thru polyclinics every 6 months still?

    By Blogger aliendoc, At May 23, 2006 10:09 am  

  • .... and they didn't mentioned the higher consultation fees.

    Wonder how it's going to affect the poorer patients?

    Guess it's not 'one patient, one physician' then.

    By Anonymous Anonymous, At May 23, 2006 3:17 pm  

  • I agree that numbers will probably be the limiting factor here, but I suspect that this is just part of the 'grand plan' which also involves the family medicine specialist register, withdrawal of Medisave for outpatient treatment, block budgeting, and perhaps means testing. The report also mentioned that private GPs will be roped in, but did not reveal the scale of this move.

    The higher consultation fees was mentioned in Weekend Today:

    "Having family physicians at polyclinics who focus on chronic conditions will solve this problem — but the catch is that patients have to pay more, up to about $20 for consultation as opposed to $8. The medication, however, will still be subsidised."

    Overall very little information to really make an assessment of the whole project, but the idea of using Medisave for better primary care and control of chronic conditions rather than saving it for hospital care when the chronic condition is out of control seems a sound one.

    My only concern is that there seems to be a bit of over-enthusiasm as seen in the second part of the Today article - to have zero sick or in-hospital patient is clearly unrealistic.

    A development worth watching.

    By Blogger angry doc, At May 23, 2006 5:28 pm  

  • not all the medication are subsidised.

    By Anonymous Anonymous, At May 23, 2006 5:58 pm  

  • Dr Donald Duck:

    Cuter than your choices so far... :P

    By Anonymous Anonymous, At May 23, 2006 9:20 pm  

  • Wow!... just visited the polyclinic and was very surprised that patients of the Family Physician Clinic has a diff counter for registration and in some clinics the counter is situated far away from the normal registration area where all the other sick patients are. The service is lst class, something you don't get as "ordinary" patients

    And in most clinics you have 2 "special" docs to choose from.

    By Anonymous Anonymous, At June 14, 2006 5:40 pm  

  • Thanks for this post, quite helpful material.
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    By Anonymous Anonymous, At December 30, 2012 3:01 pm  

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