In March 2022, Health Minister Ong Ye Kung announced the Healthier SG initiative, which aims to promote healthy living by encouraging every Singaporean to have one regular family physician.1 Public consultations are being held, as well as meetings with various professional bodies and organisations.2
At the Ministry of Health (MOH) Work Plan Seminar held on 3 June 2022,3 Minister Ong Ye Kung shared the broad guiding visions for national healthcare in the coming years:
I summarise below some of the key points discussed.
- Live well, leave well – improving palliative and end-of-life care
- 77% of the respondents preferred to be cared for at home, but only 26% of Singaporeans passed on at home
- Raise wareness of end-of-life planning
- Smoothen discharge procedures and scale up palliation support at home
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Provide better support for caregivers
- Everyone encouraged to take ownership of one's own health
- Good to download and use these two apps: HealthHub SG and Healthy 365
- Incentivise healthy practices
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Improve the Healthy 365 app's compatibility with commercial health apps
- Healthier SG – one Singaporean, one family doctor
- Fair remuneration for doctors
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Use of health plans for patients to follow
- Strengthen the network of local community-based support
- Community partners such as People's Association, Sport Singapore, etc
- Eldercare centres to almost double by 2024
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Agency for Integrated Care and Silver Generation Ambassadors
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Ageing well, ageing in place
Ground implementation
It is great that there is a national alignment of all healthcare resources towards keeping healthy and preventing illness. Having this global vision helps each organisation to better direct resources to support it. It is truly humbling to see how doctors are just a small part of an entire complex ecosystem, and we need to acknowledge this to more effectively help patients make real changes.
We see the patients but for a short time in the consultation. We see them in their identity as a patient, but to them, their whole lives are centred around so many more roles – their families, their work, their self-identity. Simply saying to a patient, "you need to exercise, you need to lose weight" is not enough. Place yourself in their shoes. What other conflicting factors are there that prevent them from doing so? We will have to rethink and take part in the revamp of the "traditional", top-down approach of doctor-led healthcare protocols. Would a home visit help? What about neighbourhood-based activities? Should the workplace also set aside a protected time for wellness, both physical and mental?
Thinking back to my years working in a restructured hospital as a junior doctor, I just needed to focus on the patient in front of me, clear my examinations and complete my training. Volunteering with the SMA Council has taught me a lot about how doctors influence the healthcare sector.4 Now, with the different perspectives I have gained from all my various positions, it can be rather overwhelming when I see how small a role doctors actually play.5 Sure, doctors are perhaps the most visible aspect of healthcare, but we are like medium-sized fish, in an entire ocean of marine creatures – and we are all at the mercy of the current!
Sometimes, it feels like nothing can change and yet, I believe that each and every one of us can be an agent for positive change. By having good leadership, setting good examples for the people around us, and showing how to make a difference, many small ripples can build up to a wave. Let us each do our own small part, in our clinics, with our staff, and with our patients.
Professional advocacy
For practitioners, do keep an eye out for any discussion groups on how these health policy changes will be carried out, and actively share your views. Concerns over reimbursements, corporate insurers, accessibility for patients, transfer of care, and cybersecurity6 are common, and there are some solutions being discussed. In numbers, we have strength, and the SMA is the voice of doctors. But the SMA Council does not know everything, and we need to hear from you. Speak up, send in your thoughts to sma@sma.org.sg.
In recent years, there have been many engagements by Ministry of Health with professional bodies and the ground over issues of legislation, revamps of the Medical Registration Act and Singapore Medical Council Ethical Code and Ethical Guidelines, integrated shield plans, doctors in training, and more. I am glad that these efforts are recognised by some, and yet, I still hear complaints about "SMA doing nothing". Best of all, some of these doctors did not realise that I am a SMA Council member when they aired their complaints to me.
There is also another interesting phenomenon, that when I am introduced to some doctors, they are very excited and they proceed to tell me what I should be doing, as SMA President. For context, these are colleagues who do not know me as a person and have no knowledge of my abilities, but are keen to tell me how I should be doing things. There is a difference between giving constructive feedback, sharing a personal opinion, and mansplaining;6 rest assured, for I can tell the difference.
What do these imply? Is the SMA still not active enough? Or could it be that these doctors are not taking the time and interest to learn about what the SMA has done?
Like many professional women I know, I am a constant worrier. I worry about my large family, my patients, the business aspects, the family finances, my weight, my health! Yet, I also know that, "worrying is of no use". Acceptance, and moving ahead is the only way forward. Now that my kids are older and attending primary school, I try to take time off for them during the June and December school holidays. I better appreciate how precious time is because one can really have a sudden catastrophic illness which derails one's life's plans, and life may never be the same again.
This month, I shall introspect, reflect and re-prioritise. Only fellow volunteers in professional bodies understand how much time we put into our advocacy work, and the many small sacrifices we make to do what we can for the larger good, with no expectations for personal gain, but only to try to do our small part to improve the system.
What matters to you? How will you spend your time meaningfully? To always contribute good to society and the people around you? Or to be self-centred, and ask for people to change for you, to do things for you? How do I balance public service ethos against self-care? There is no right answer – only you can decide what the right balance is for you.
For all my peers and younger colleagues, I hope you find good mentors to guide you,7 so that you never lose the passion for medicine, and do not burn out too fast, too young. For some of us who might be burnt out, dejected and cynical, I wish for you a good period of rest, rejuvenation and revival.
Take care of yourself, so that you can go on to take care of others.