'Preventive health is the cheapest medicine': GPs welcome move to get people to enrol with family doctor

SINGAPORE: General practitioners (GPs) said that a move to get people to enrol with a family doctor as their first line of care will allow them to detect and diagnose diseases earlier and potentially buy their patients years of better quality of life.

The move to invite residents to register with a GP or polyclinic doctor of their choice from next year was announced by Health Minister Ong Ye Kung during his ministry’s Committee of Supply debate on Wednesday (Mar 9).

The initiative will likely start with those in their 40s and above, Mr Ong added.

Speaking to CNA following the announcement, Dr Mark Yap, who runs a clinic in Bukit Panjang, gave the example of a patient whose parents have diabetes. Given the family history, it is likely that the patient will get diabetes in his lifetime, he said.

“The earlier I can see you and I can educate you and we can delay the onset of diabetes, let’s say instead of catching it at 30, you catch it at 50. I am buying you 20 years of quality of life,” he said.

He added that this may in turn reduce the chances of further health complications as a result of diabetes.

In addition, healthcare resources can be better managed and this will help patients spend less on medicine over the long-term, Dr Yap said.  

“Preventive health is the cheapest medicine,” he said, adding that the move is "long overdue".

Similarly, Dr Elly Sabrina, a GP in Woodlands, said that detecting abnormalities with a patient she is already familiar with is much easier.

“You've seen the patient for years and suddenly you detect certain symptoms and signs, for example, they might be developing Parkinson's, rather than if I see the patient for the first time. It's not easy to work on an empty page,” she said.

DEEP TRUST AS FOUNDATION

Dr Philip Koh, who runs a clinic in Tampines, said that beyond allowing doctors to pick out diseases early, seeing the same doctor will boost familiarity and trust between both parties.

“This doctor-patient relationship is sacred to the well-being of a patient through his life. It takes time for trust to be built and at the end of the day, it’s all about trust,” Dr Koh said.

Illustrating his point, Dr Koh recounted a time when a patient’s family called for advice on a life-or-death situation. Diagnosed with cancer and with possibly only one week left to live, the family wanted to know if the patient should undergo an expensive treatment.

“As you grow older, you will encounter decisions of this nature … sometimes, in the state of sickness you're not able to make the right decision yourself. You need someone who you trust and who is able to give you the best advice," he said.

Associate Professor Tan Tze Lee, the president of College of Family Physicians Singapore, echoed the view. 

The essence of having a family doctor is the development of a deep and meaningful relationship between patients and their chosen family doctor, he said.

“(It is) the deep trust and confidence they have that their doctor would do the best for them and will seek the best care for them,” said Assoc Prof Tan, who has a clinic in Choa Chu Kang.

“It is this relationship that is built up and developed over time that helps to promote better health and better outcomes.”

MORE THAN “COUGH AND COLD DOCTORS"

GPs who spoke to CNA said that more of them are now specialised in family medicine.

“I think all these years, the impression of most of the public is that we are cough and cold doctors … though we can do much much more,” said Dr Vincent Chua.

For instance, he offers knee injections, and is trained to stitch up wounds in his Tiong Bahru clinic. 

In addition, GPs also do vaccinations and conduct house calls to the elderly who are home-bound, said Dr Yap.

“Family medicine is actually quite holistic in the sense that not only do you look at acute problems, you look after chronic problems, not only do you look at a certain age group, but it cuts across all age groups,” he said.

POTENTIAL ISSUES

While the doctors largely supported the move to have patients enrol with one primary care doctor, they also pointed to potential pitfalls.

One common scenario they brought up was of working adults seeking treatment at clinics under their company’s insurance coverage.

Dr Chua said this “big category” of working adults is a group of patients for whom this scheme is “not likely to work”. 

“The reason why they see a doctor is not that they like me or I'm good. It’s because they don’t have to pay,” he said.

Assoc Prof Tan added that if patients are restricted to one clinic, they might have a problem if the clinic is closed when they are unwell.

While changing doctors may be inevitable for some patients, one way to minimise disruption is to get a recommendation from the first doctor, said Dr Koh.

He added that he has recommended his patients to other doctors, and has also received new referrals.

“Because of that communication, if there's anything (I need to find out), I can always go back to that doctor,” he said.

The doctors CNA spoke to said they all look forward to seeing how the scheme will be rolled out.

“Everybody agrees that the devil is in the details,” said Dr Yap.

The Health Ministry had announced that over the next few months, it will consult stakeholders, including members of the public, GPs, healthcare workers and community partners, to gather their views.

It will then provide more details in a White Paper and table it for debate in Parliament, adding that it will share more details of the public consultation plans when ready.