'Treat the patient, not just the illness'

Photo above: Prof Chin hopes future doctors can "modify the care, yet not deviate too much from evidence-based medicine".

THE focus is on the patient - not just his ailment - so students at the new Lee Kong Chian (LKC) School of Medicine will interact with patients from their first year.

The school, jointly run by Nanyang Technological University and Imperial College of London, opens next year with an intake of 54 students.

Its Assistant Dean for Integrated Care, Associate Professor Chin Jing Jih, said that with Singapore's ageing population, "we have to change the way we teach students and expose students to the kind of care that is happening on the ground".

Previously, patients with, say, fractures were warded for surgery and given a few weeks' medical leave before they went back to work.

Today, many are older patients who need rehabilitation - and possibly other help - to get back on their feet.

Tan Tock Seng Hospital (TTSH) will be the site for the bulk of the clinical training for LKC students. They will track a patient's progress from the time of hospital admission to the stay in a nursing home and outpatient rehabilitation.

Said Prof Chin: "This way, no matter whether they become orthopaedic surgeons or family doctors, they will have a better idea of the whole treatment process."

Associate Professor Tham Kum Ying, a senior consultant in emergency medicine at TTSH, said that when she was a young specialist, her attitude used to be: "What came before, blame the paramedics, they didn't do a good job. What comes after is none of my business, I've handed over the case."

But she now emphasises the need to keep the big picture in mind.

Last year, TTSH made it a practice to offer patients with fractures a urinal or bedpan to relieve themselves every two hours while at the emergency department.

This is very important to both the patients and the hospital, she said, as it significantly reduces the risk of getting urinary tract infection later in their hospital stay - simply because they did not empty their bladder.

She said: "A lot of patients are very appreciative of this as they feel paiseh (embarrassed) to call a nurse, especially in a busy emergency department where everyone is doing something."

She wants LKC students to develop the mindset that it takes a team to treat a patient, not just the doctor.

Prof Chin, who is a senior geriatric doctor at TTSH, said LKC students will learn "implementation science".

"Textbooks are very neat. For this disease, give this treatment. But if you can't frame the treatment to suit the patient, he won't comply," he added.

He gave the example of warfarin, a medicine used to thin blood. Patients are supposed to avoid food rich in vitamin E but most do not do so as they want variety in their diet.

So instead of telling them to avoid eating spinach, for example, he might prescribe a different dosage. This has resulted in far better control, he said.

He wants future doctors "to modify the care, yet not deviate too much from evidence-based medicine".

At the Yong Loo Lin School of Medicine at the National University of Singapore, students start interacting with patients from their second year.

They do not follow a patient through to recovery but are exposed to the various stages of patient care during postings.


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