30th Anniversary Dinner Of The College Of Family Physicians

26 Aug 2001

By Mr Lim Hng Kiang

A/Prof Cheong Pak Yean, President, College of Family Physicians

Distinguished Guests

Ladies and Gentlemen

It is my pleasure to join you this evening at the 30^th Anniversary Dinner of the College of Family Physicians.

I would like to commend the College on your continued commitment towards excellence in Family Medicine and I would like to express the Ministry's support of your efforts. The College of Family Physicians has worked together with the Ministry of Health and the Graduate School of Medical Studies in the National University of Singapore to put in place the Master of Medicine in Family Medicine (MMed FM) and also the Graduate Diploma in Family Medicine (GDFM) programmes.

From a humble beginning of 9 doctors who obtained their Masters in Family Medicine in 1993, you now have 140 doctors with this Masters degree. Beyond the Master's level, the College has a Fellowship of the College of Family Physicians, Singapore (FCFP(S)) programme to further develop family doctors for leadership, research and training in the field of Family Medicine. This Fellowship by Assessment programme encourages those who have completed their Masters in Family Medicine to pursue an advanced training programme for another 2 years . The aim is to encourage family physicians to develop areas of interest e.g. in fields of aged care, ambulatory care and palliative care. The Fellowship by Assessment programme is an innovative concept which empowers and gives due recognition to family physicians who aim to excel in their specific areas of interest not only through 'hands-on' practical training but by participating in training of other doctors as well by research and other academic activities. Today, the first 7 Fellows by Assessment will be receiving their awards given by the College.

May I extend my warmest congratulations to all of you who are receiving your awards today as well as to the College, on your efforts and initiatives, which will contribute to raising the levels of professionalism among family physicians in Singapore.

The Role Of The Family Physicians

The family physician or GP plays a critical role in the delivery of health care in Singapore. GPs deliver over 80% of the primary health care in this country. Being the first line of contact, you must be in touch with the demands made by the public on doctors in this new millennium. You need to be aware of your pivotal function in the delivery of quality primary health care in the face of the changing landscape of an ageing population, increase in lifestyle related chronic diseases, rising health care costs, rapid technological advances, and an increasingly Internet savvy population who have access to medical information at the touch of a button. Let me approach these issues one at a time.

The Aging Population

Family physicians serve as valuable partners in complementing and supporting the various community based services for the elderly. You need to be aware of the availability of community based and home based services, so that you can also serve as de facto case managers for your elderly patients.

In addition, the Ministry recently established the Primary Care Partnership Scheme, in which GPs are given government subsidies for providing care to the needy elderly. This provision allows the GPs on the scheme to look after more elderly people living close to the clinic, who may otherwise not be able to afford the GP's charges.

Apart from the case manager role, the family physician should be the primary physician to manage his patient's needs. You are in the best position to advise a patient on the different types of treatment that he receives from the different specialists. In doing so you can ensure a patient is not subject to unnecessary duplication in therapy. Only with greater understanding of the scope of the different modalities of treatment via continuing professional education or by pursuing advanced training can the family physician truly be in a position to advise his patient appropriately. The launch of the new Family Medicine Fellowship Programme in Aged Care is therefore a step in the right direction. It empowers the family physician with additional training in aged care to be the primary physician for his elderly patients, co-ordinating care at hospital and community levels.

Chronic Lifestyle Diseases

As Singapore becomes more developed and affluent, we now face many ills caused by our sedentary lifestyles, by stress, by smoking and by unhealthy eating habits. We need the family physician to be actively involved in all aspects of primary prevention such as rendering health education and in screening for diabetes, hypertension and high blood cholesterol levels. The successful implementation of the national control programmes for major chronic lifestyle diseases like hypertension, diabetes mellitus and stroke is very much dependent on family physicians. A few words of advice on your part can motivate your patients to live healthier lifestyles which can prevent or delay the development of these chronic diseases.

Curbing Healthcare Costs

Every Singaporean has access to a good level of healthcare at affordable cost. This means the most cost effective and appropriate mode of medical care when they see the doctor. International data has shown that well trained family physicians equipped with the necessary expertise can diagnose and treat up to 90% of the common medical problems seen in the population. Family physicians need only refer complex cases requiring specialised care to specialists, effectively helping to curb health care costs for the individual and society. In Singapore today, on any one day, some 23% of patient visits are to specialists, 2% are to A&Es and 75% are seen by family physicians. There is a tendency by Singaporeans to seek specialist care when in fact they can get the same attention from their family physicians. With better trained family physicians, we should be able to work towards a primary care based system, which is more cost effective.

Advancing Medical Technology and an IT Savvy Population

There was a time when a patient came in for a consultation, answered dutifully when asked the history of his condition, sat silently while the doctor conducted a physical examination and scribbled a prescription, said thank you and left the room to collect his medicine without questioning the doctor. Increasingly this scenario is changing. Nowadays the well-educated patient, not only comes armed with the possible diagnosis of his medical condition, obtained by surfing the Internet, but also asks the doctor to recommend the best treatment from all available options that the patient is aware of. To cope with such patients, the family physician has to constantly update his knowledge and keep up with the latest medical developments.

Professional education does not and cannot come to an end with graduation from a Medical School. One of the ways a GP or family physician can achieve this, besides surfing the same websites visited by his patients, is through Continuing Medical Education (CME) and through the pursuit of courses provided by the College.

The College, as I understand it, also plans to modularise training and to employ more distance learning and web-based teaching for the convenience of doctors who wish to follow such courses in their own time in between their busy clinical duties. Such on-line courses need to be publicised, so that doctors are aware and can make use of them.

Conclusion

As you go on with your pursuit of life-long learning and upgrading, I would like you to pause a moment amidst your busy schedules to remember that the patient who comes to you is a human being with complex emotions, problems and fears. Your duty is not only to render treatment with a high level of skill and expertise but also with a touch of humanity and kindness. This is a basic tenet of family medicine, a 'high touch' discipline, which all of you know, but may sometimes forget due to your day to day busyness .

On that note, I once again congratulate and commend all of you who have risen to the challenge by committing your time and energies in pursuing and successfully completing the various courses in Family Medicine offered by the College of Family Physicians. Like the pioneers who built up this nation, your exemplary efforts in embarking on this journey of excellence will pave the way for many more to follow. You play an important role in the healthcare scene. I thank you.