SINGAPORE: As doctors, we are trained to treat illness. Patients come to us when they are ill, for medical care, for tests, pills, surgery, treatment. Illness care is key to healthcare provision.
And as medical knowledge grows, medicine gets more and more complicated. No one doctor, one healthcare professional, can know it all. The provision of healthcare is therefore now more fragmented. We have more and more people involved in caring for an ill patient.
Even as this much-needed improvement in knowledge and the ability to treat illness more effectively grows, we have inadvertently also lost two key foundation pillars of healthcare - foundations set up by leaders in the medical world such as Sir William Osler, whom young medical students learn about even as we also learn anatomy, physiology and pharmacology.
HEALTHCARE IS NOT ONLY ILLNESS CARE
“One of the first duties of the physician is to educate the masses not to take medicine,” said Sir William, who has been called the father of modern medicine.
Prevention and wellness have also been the key tenet of health. It was often the only option when Singapore was young, money was tight and there were few doctors, let alone hospitals. People had to take responsibility for their own health, eat healthy, exercise and so on.
The few healthcare professionals played a role in education, supporting patients and, when needed, provide care as best they could. Hospitalisation was only as a last resort.
(File Photo: SGH)
Most of the care was provided at home. This is still true in many developed countries where accessibility to clinics and hospitals is either geographically difficult - it is far to travel - or systems are in place to promote healthcare in the community.
Care was also provided not only by trained healthcare professionals but also the greater community of family and friends - the kampung spirit.
Neighbours would pop by for a meal when someone was sick, as it was acknowledged that good health was not just dependent on pills or hospital beds - but that food, friendship and knowing that you were not alone played an equally important role in the road to recovery.
Caring for the spirit, and not just the providing the science, makes for better health and illness care.
THE PATIENT IS A PERSON
Sir William also observed that it is much more important to know what sort of a patient has a disease, than what sort of a disease a patient has.
Medical students are taught anatomy, pharmacology, the science of medicine. As they progress to become doctors and specialists, they learn more and more about smaller and smaller parts of the human body.
We now have cardiologists (heart specialists), orthopaedic surgeons (bone specialists), ophthalmologists (eye specialists) and so on. This specialisation is essential as medical knowledge grows and indeed, with specialisation, our ability to effectively manage complex diseases grows.
But patients are not body parts. They are people.
The patient-person is not only the physical body with the heart, lungs, kidney, liver and brain. He is also emotion, spirit, faith. He/she is also a father, mother, brother, sister, aunt, son and daughter. He is also part of a community of neighbours, a member of the workforce.
(File Photo: Home Nursing Foundation)
Treating illness and helping our people keep healthy require us to recognise that our patients are people. That as people, we need more than just pills, tests or hospital beds.
MAGIC, BUT NOT IN A PILL
When Channel NewsAsia first approached me to help out in its documentary project Turn Back the Clock, I thought it was a gimmick, something to do for TV audiences. To be forgotten after the show was aired.
(Editor: The concept was to take five seniors in their 70s, and make them live together for a week in an environment that simulated their 1970s heyday. They were made to live independently again, without helpers, and to engage activities they had not done in years - on the premise that this would help reverse the ravages of ageing. Read about it here.)
I was sceptical because, after all, the science is solid that one cannot improve physical and mental ability within a week - especially with no pills or professional intervention with all our high-tech equipment, injections and surgery.
I was wrong.
I watched our five heroes change not only physically, but also emotionally and in their ability to move, to do things.
WATCH: The transformational ‘Turn Back the Clock’ experiment. The final episode airs Jan 16, 8pm SG/HK. (2:23)
There was no magic pill that they took. But perhaps there was magic.
The magic was what, as doctors, we often forget - that of recognising that healthcare is not illness care. The magic that the patient is a person.
I watched our five heroes eat well, move well, exercise, and become a family. I watched them support and encourage each other, cry together, laugh together.
I watched them heal each other. To be the best that they could be, despite their real diseases and disabilities. I watched their scientific health scores improve, when tested objectively after the five days!
Dr Carol Tan with Madam Asmah Laili.
LESSONS FOR ALL
Asmah Laili’s diabetes will never go away, neither will Harry Chin’s stroke. But they are just diseases; diseases that they will have for the rest of their lives. Even as their doctors and healthcare professionals will do their best to care for them, our five heroes have taught us two key lessons in turn.
They have reminded us that given the right support and encouragement, every patient-person can help himself; that together we can be healthier, have hope, something to look forward to everyday.
WATCH: A 76-year-old rediscovers herself
They also taught me as a doctor, that I must never forget that my patient is a person. That it is much more important to know what sort of a patient has a disease, than what sort of a disease a patient has. For this, I thank them.
I only hope more can learn this lesson - whether we are politicians who lead ministries; policy makers who decide budgets; hospital planners and architects who build the hospitals, nursing homes and day care centres; or doctors, nurses and healthcare professionals who work in the hospitals, health and social services.
And most importantly, the community, neighbours, friends, family. We will all grow old one day, but it is a lesson not just for the old.
Good health is what all of us want, whether we are 20 or 80. We each have a part to play to keep each other healthy as people, and not patients.
Dr Carol Tan is a geriatrician by training and chairs The Good Life, a healthcare cooperative. She spearheads a number of active ageing programmes.
Catch up on the four-part documentary, Turn Back the Clock, here on Toggle.