If you think of  a nation’s health as a pyramid, it's the base that has the biggest representation and that  needs to be managed well. 

Feature Story

MOST of us only see a doctor when we fall sick. And it's usually for an acute problem such as a cold or bad stomach.   In addition to episodic visits for acute problems,  how about seeing that same doctor when you're feeling healthy and perfectly fine?  

What if there could be a different approach to primary healthcare?   One that emphases preventive health, delivered by a family doctor with whom you have built a relationship and who is committed to helping you manage your health throughout your life course.      

“It's what we call the life-course approach to primary care,” explains Dr Tan Sai Tiang, one of the doctors at Hua Mei Clinic. There should be an (urgent) shift towards this approach to primary care  she advocates, and this is important for two main reasons.

Firstly, there has been an epidemiological shift from infectious, communicable diseases to non-communicable, lifestyle-related chronic diseases. Secondly, we're an ageing population.

With lifestyle related diseases like diabetes and hypertension, there is a place for preventive measures at different levels; at the primary prevention level where a healthy lifestyle can prevent or delay the development of disease, at the secondary level where appropriate screening and early detection/treatment can prevent the development of complications like stroke.

Thus for these lifestyle –related chronic diseases, the patient is in charge of his health and the doctor’s role is to help the patient effect therapeutic lifestyle changes to manage the disease. But for a doctor to partner with you on your health, it means that you need to build a relationship with your doctor - one who will know you well enough to understand your lifestyle and health patterns and thus able to advocate appropriate preventive health measures at different stages of your life.  

The second reason for advocating a different approach to primary care is our geriatric population. The elderly manifest diseases in a different manner, are afflicted with more medical problems and take more drugs than an average adult. Without a dedicated primary care doctor, medical care for the elderly tends to be fragmented and health outcomes unsatisfactory and even life-threatening.          

The Hua Mei Centre for Successful Ageing has long been advocating this form of age friendly primary care approach; and in 2004, was chosen by the  World Health Organisation as a pilot site for an  Age-Friendly Primary Health Care Centre. To be an Age Friendly Primary Health Care centre, three principles have to be fulfilled to overcome barriers of care to the elderly person.

The first principle addresses attitude (or ageism concepts), education and training of the health care provider; from the doctor to the front desk personnel. . “For a young adult, the focus is to get well (cured). For the elderly , the end point of care may not be to cure but to  remain as functional as possible,” explains Dr Tan.

The second principle addresses barriers to care as a result of system deficiencies such as seeing a different doctor at every visit, missing medical records and having to go to multiple locations to get holistic care. Finally the last principle addresses physical barriers such as lack of wheelchair access, confusing signages at health care facilities etc.

In Singapore, it is (unfortunately) difficult for the average GP to operate an age friendly clinic because primary care is the least funded (by the Ministry of Health) and not recognised as much as it should be.  If you think of  a nation’s health as a pyramid, it's the base that has the biggest representation and that  needs to be managed  well. “If the base is strong and trouble free,  there's no need to spend big money on  the top tier which is also the most expensive,” says Dr Tan.

Hopefully as the populace becomes more educated and sophisticated, they will recognise the importance of this type of primary care and be prepared to pay for their doctor to keep them well and not merely pay for treatment of an established ailment. Hua Mei Clinic has a small but growing base of persons in their 40s who do regular consulting, says Dr Tan. “ Some have no medical problems but see me once a year for regular screening and health promotion. Some have uncomplicated chronic disease and see me once in six months as they have been educated on how to manage and track their medical condition.

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