How to reduce wait for specialist appointments

There are many reasons for overcrowding in our public hospitals and the long wait for specialist appointments ("Specialist 'shortage': Relook training system" by Dr Thiruppuran Kuperan; Oct 7).

First, our population has increased and our demographics have changed.

Also, our affluent lifestyles have brought forward the onset of chronic diseases such as diabetes and hypertension.

Second, our health-care system has become more sophisticated. We now have specialists who sub-specialise in many obscure and previously untreatable conditions.

"General specialists" are rarities now.

Third, medical practice has evolved to become more evidence-based, resulting in many clinical practice guidelines. These developments ensure safety and reduce litigation but, when followed too rigidly, may frustrate the public.

All these developments require new and innovative solutions.

First, greater emphasis must be placed on disease prevention. The public must be educated to change its mindset. Also, our working and living environments must be re-engineered to facilitate that.

Health-care workers such as pharmacists, nurses and therapists can lead the way, as part of their community outreach efforts.

Second, primary-care doctors must play a bigger role. Instead of referring patients to hospitals, these doctors should be able to treat most of them.

For instance, a patient with early renal dysfunction can be managed by a family physician.

Family physicians are able to look after patients holistically. There are many well-trained family physicians in public hospitals; they can help the specialists attend to patients, and refer the more serious cases to their specialist colleagues.

Third, the financing of health care needs to be tagged to the individual and not the facility, so patients can enjoy subsidies in both private and public health-care facilities.

This will encourage them to see the doctor most convenient and affordable to them, freeing up specialists in public hospitals to treat the more serious cases.

Leong Choon Kit (Dr)

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