The middle-aged man had diabetes, yet he did not seem to take his health seriously. He was disinterested in his own well being, did not control his diet and habitually missed his medical appointments and blood tests. If his diabetes continued to be poorly managed, he was at risk of developing complications such as kidney failure.
"The challenge lay in addressing his preconceived notions regarding his disease and trying to get him to see the doctor's point of view and to accept that early interventions are critical," said Dr Rufus Daniel, a primary care physician at Woodlands polyclinic. "Should we spend another 15-20 minutes with him in the hope that one day he will listen, change and possibly avoid amputation or kidney failure? Is the time spent on him justifiable, given that there are many patients waiting outside who will listen and allow you to care for them swiftly?"
This patient was one of the challenging cases that Dr Daniel encounters in his work as a family doctor in the public sector. To him, the key to patient care lies in empathy, which he describes as "treating people as rational human beings who are willing to help themselves if only they understood the illness they are dealing with". It is an essential quality that makes his work more meaningful: "It makes me better, and often faster, which is a good thing in a busy polyclinic".
The 44-year-old deputy head of Woodlands polyclinic was one of the 61 recipients of this year's Healthcare Humanity Awards (HHA). The annual awards, established in 2003, are given to outstanding and inspirational healthcare workers in recognition of their selflessness, compassion, humanity, courage and extraordinary dedication to their patients.
While not every patient responds well to Dr Daniel's efforts, those who do reap the benefits of better health. Another diabetic patient paid heed to Dr Daniel's explanation of his condition and what he could do to help himself. He came to understand the need to take responsibility for his own health. "His diet control improved, he exercised more and compliance with medication became complete," said Dr Daniel, who noted that being empathetic is "the only way to get through to" patients.
"Our patients are people, and people respond best when treated with respect and empathy," he said.
Besides caring for his patients, Dr Daniel has also led several patients to help enhance the clinic's operations since joining it five years ago. He has been commended for taking time to understand and manage patients' concerns as well as responding to staff feedback on new processes.
Dr Daniel shares with YourHealth what life as a senior family doctor in a busy polyclinic is like.
What is your typical day at work like?
On a typical day, I start seeing patients at 8am and break for lunch at 1.15pm. I resume my work at 2pm until I see the last patient of the day, which is usually around 5.30pm. My usual routine during consultation includes going through patients' past medical histories, finding out more about their conditions and addressing their concerns. I also order lab tests for patients and explain the results to them, plan the next step of treatment, prescribe appropriate medication, and try to motivate them to self-manage their conditions.
What are some of the most challenging aspects of your job as a family doctor?
The most challenging aspect is time management. All of us work extremely hard and the mental demands are continuous and increasing in complexity as newer protocols create more levels of interventions for the primary care doctor.
Adding to that is the patient load we see in polyclinics. The doctor must strike a balance between spending adequate time with patients while making sure others don't wait too long. Efficiency becomes paramount - to use minimum amount of time to reach correct clinical decisions and explain it to patients (the latter being the most laborious, yet if done well, is one that will reap the greatest long-term benefits), and last but not least, documentation of cases.
What keeps you in Woodlands Polyclinic as a family doctor?
As a polyclinic doctor, the daily work is demanding with high patient volume. Often this is seen as the greatest stress upon us but patients come to us because we are more affordable than private practitioners, so I see my role as a doctor here both as a job, as well as a service to these patients.
In addition, the spectrum of cases seen in polyclinics is far greater than in the private sector, thus enabling me to keep my clinical skills well honed. Chronic care is where the greatest difference is felt as polyclinics see far more patients with diabetes, hypertension, high cholesterol levels and ischemic heart disease than doctors of similar training and experience in the private sector. It is a demanding yet intellectually satisfying job, which is what I yearn for.
What, in your opinion and observation, makes a good doctor?
A basic love of science should be where it starts. Add to that an interest in the incredible complexity of the human body, and the motivation to keep it in good health will come along. Without this, the continuous learning required in medicine will be difficult for most people.
Next is stamina. Medical school and the life of a doctor are physically, mentally and emotionally demanding, and most of us choose this career because we like the challenge. Last but not least will be empathy, the ability to treat people as they are and with their own motivations. Once you see their point of view, they will be more willing to see yours.