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EXCERPTS FROM “VISION 99”, AN ARTICLE BY A/PROF CHEE YAM CHENG IN SMA NEWSLETTER, NOV/DEC 87
Editor’s Note: In this month’s commentary, A/Prof Chee Yam Cheng revisits an article he wrote 12 years ago in the SMA-Newsletter of 1987 titled ‘Vision 1999’. In that article, he laid out his vision for a more rational system of vocational training of doctors and a better integrated delivery system by 1999.
Only last year in 1999, the specialist register was formalised. The move towards achieving better integration of the healthcare system and mandatory CME were announced. There is now an incipient move to set up a vocational training programme for all primary care doctors and with it the seed of the Family Medicine register.
A/Prof Chee wrote in 1987, “This is the challenge ahead. We have about twelve years to achieve. I am optimistic we can.” How much of that ‘Vision’ has come to pass?
The SMA-News is republishing excerpts from the 1987 article for you to reflect. Other excerpts from the article are commented by The Hobbit in “Personally Speaking” on N5. We are reminded of a quotation from Sir Thomas Browne, a role model of Sir William Osler, “There is no road or ready way to virtue. To perfect virtue, as to Religion, there is required a Panoply, or a complete armor.” (Bryan CS Osler - Inspiration from a Great Physician, Page 39, Oxford University Press 1997).
On
a rational schedule of training and apprenticeship
“By 1999, the Singapore doctor would benefit from a planned, rational
schedule of training and apprenticeship – from housemanship days till
he becomes a specialist on the specialist register. No effort is spared
to ensure he succeeds. Dropout and wastage should be zero. If he opts
to be a family physician, that should also be recognised as a specialist
post. The frontline in any battle against ill health should be actively
supported. There is no place for frontline fodder. The frontline must
be effective.”
On
the role of specialists and the specialist register
“The specialist register would be a reality and so too would continuing
education be part and parcel of every doctor’s (specialist or not) life.
Those not prepared to accept this (that learning in medicine is for life)
would be wise not to enter medical school. The public and private hospitals
would then be able to pick and choose the better ones who can contribute
to continually upgrading standards of medical practice. And because they
are good as well as humble and inbred with a sense of debt to society
(editor’s italics), they would contribute their skills and time to succeeding
generation of doctors and of course to patients.
Remember then that the public cannot be fooled anymore, not that they were fooled before. But they will be better educated and more aware of improperly trained doctors who may instead be good businessmen alone… Therefore if specialists rush to leave government service, please do; but only after they are well trained, locally and/or abroad. Hopefully the specialist register would see to that.”
On
the role of GPs and a family physician register
“To upgrade general practice, there must be a training schedule, while
in government service, to expose such doctors to the relevant discipline.
A GP is not a dropout of the system meant to train specialists… There
should not only be a register for specialists but also a proper register
for general practitioners. Quality of training, experience and the commitment
to continuing medical education must be the pre-requisites.
Unloading the hospitals of simple problems GP can handle would change the image of such doctors as cough and cold doctors. The GP should be trained to handle and be allowed to handle more than what he does today.
The family unit must remain intact. The family physician could try to ensure healthy families through the many preventive medicine schemes, proper guidance and health counselling. When the specialist is required he would work with the family physician whose patient he helps to manage rather than take over.“
On
the role of the public
“In 1999, the public would expect nothing less of doctors - doctors trained
properly to do the job, with the correct attitude towards families and
patients. Trust is understood to be present and the patients and public
need not fear being taken for a ride. The public being more educated would
make decisions where possible on their health matters. The public would
understand the ethics, the clinical judgements and the socio-economic
implications of their decisions. To a certain extent, no money could mean
no treatment unless they qualify for subsidies.
Who should government subsidise and whom should government not subsidise? The indigenous will continue to be subsidised and even receive free treatment. For the rest, it will depend on the prevailing times.
By 1999, would that be our position? … (like) in Scandinavia (where) the public attitude has reached the level where even in non-emergency situations, they would willingly and freely donate their blood to the State and ask no more questions about what happened to their donations.. not asked to be paid in cash or in kind… and is not interested in receiving anything in return.
The public must do its part. Being better educated, they will understand the problems Singapore faces. An ill patient is not a doctor’s problem per se. The family must assume responsibility – in illness and in old age. The hospital beds should be used only by those who need them – not as hotel beds, not as a home away from home and not as hospice beds either.”