GP as a Co-ordinator

"Doc, you are the 5th doctor I am seeing this week..."

"Hi, am sorry, need your help to sieve through all these tests and x rays I did for my chest pain..."

"If I had come to you earlier, I would not need to run around to so many doctors..."

Don't get the wrong impression, I did not manage to treat any of the symptoms of the above 3 patients whom I have seen in the last 3 sessions.  If not, then why are they so grateful?

They are happy because as a General Practitioner, I have helped them understand what they have gone through.  I have helped them to decipher the technical part of their conditions.  I think they are grateful because we are friends.

First, as a missionary in my earlier working life, I learnt a lot about people.  I learnt to care, I learnt to show concern, I learnt not to be judgmental, I learnt to feel as a fellow human being, I learnt about non verbal language, etc.  So, I try to connect with all my patients the moment they enter the clinic.  It does not matter if they are babies, or they are very elderly folks, I try my best to see things from their views.  Not easy but the rewards is ministering, rewarding and humbling.

Second, as a General Practitioner trained in Public Health and Family Medicine, I have learnt to be a generalist with a helicopter view.  I am like a GPS helping my friends and patients to navigate the jungle of results done and the various mind boggling specialties out there in the hospitals.

Third, as a kaypoh (hokkien: Busy body), I have many good friends who are very well trained and excellent specialists.  They are very willing to minister to my patients as well.  They will keep me in the loop of the management of my patients.  They are keen to teach me and share with me the latest development in their fields.

Fourth, my students.  I love to teach.  Not that I have much left in my brain to teach the medical students and young doctors, but when I teach, I am forced to learnt through the preparatory work as well as learning from my students.

Finally, I attribute the last and most important piece of puzzle to a success GP co-ordinator of care to my patients.  The trust they placed in me is flattering.  With this trust, I am able to learn from them what works and what does not, what could be better and what is really the best.

Thank you everyone for helping me to become a competent GP.  I am confident you will find your GP excellent too.

What a GP can do

"Hi my daughter has dandruff, can you recommend a dermatologist for us?" "My baby is due for her vaccination, could you help recommend a pediatrician?" "I have bad giddiness this morning, should I go to the emergency department or should I see a neurologist?" I receive these messages almost on a daily basis because I am a friend who happen to be a doctor. My friends trust me to recommend the best doctor for their care. I am very grateful of their faith. However, it also poses a sort of ethical dilemma to me. In all of these, I firmly believe that all GPs can handle them very well. I would even say these area bread and butter conditions. If I were to tell my friend to see another GP or myself, I must be sure that I must not have conflict of interest. At the same time, I want the best for my friends. Here, I am referring to the most cost-effective and cost-efficient way of managing their conditions. So, the answer to the question on what a general practitioner is will provide some guidance to my friends. So, who truly is a GP? To put it crudely and a self mockery manner, a GP is a jack of all trade and master of none. In hokkien, we bao ka liao (meaning covers everything), from head to toe, from left to right, from inside to outside, from high tech to low tech. Yes, GPs can treat dandruff, GPs provide all vaccinations needed for all ages, GP can treat giddiness. Smile.

One Makes More Sense Than Eight

"one, two, three, four....eight! There are eight clinics around us!" my daughter counted excitedly one Sunday when we were strolling at our neighbourhood centre. She must be wondering if Singaporeans in our estate are all so sick that they needed 8 GPs to serve them. In my mind, I was wondering how my 8 colleagues are going to survive. At its peak, there were actually 11 GP clinics here. Three, including one belonging to one of my classmates, have bowed out over the last 10 years. Very often too, most of these 8 clinics are empty and open very long hours. I see the clinics open in the mornings on my day off, I see them open in the afternoon on my way home and I see them opened on weekends when I bring my family out for dinner. My wife thought that these GPs are super human. At one point, she even considered me lazy as I worked only short hours and a few days a week. Thankfully, she now appreciates that I spend time at home more than the clinic. My eldest son who is reading business at a local polytechnic once wondered aloud why GPs have no business sense? Probing his thoughts further, he said the obvious. "Why can't the 8 GPs open one clinic with 8 consultation rooms and pay one landlord instead of eight?" That was a gem. I was both proud and pleased with his observation and comment. So, why are we GPs not co-operating and sharing a premise and pay lower rent? Instead, why are we opening next to each other and always at the mercy of the landlord?

Forced to Play Musical Chair in Own Backyard

"Hey Bro, I am moving again. Just to make sure you can find me the next time you come." "Not again! What happen? Chased out by landlord again? Sigh." I am not sure how common this scenario is today among GPs. Sadly, I am sure it is not uncommon. My friend and fellow GP was told by his landlord that he needed to vacate his present premise when the lease expire. The landlord was not even keen to negotiate for rental increase. In other words, any offer by my friend would not be considered enough. Later, my friend found out that the landlord leased out to an ice cream shop for close to 4 times the amount he is currently paying! Really wonder how the ice cream palour can earn that kind of money when my GP friend is struggling all these years. In fact, this is the third time my friend has moved in the same vicinity in the last 5 years. Sounds incredible but it is true. Landlord thinks nothing of your business these days. Nor do they think of supporting a local GP for the sake of the community. All they are concerned is the amount they can get from any tenant. They are not even concerned if your business fails. If it fails earlier, they will confiscate the deposit and just get another willing party. In the end, the public and the poor GP suffer. Is this new to you? Not to me. Have heard of others chased out by mall management, train stations, master tenants and others. I guess the only way to over come this trend is to become landlord ourselves. Maybe it is time for GPs ourselves to help each other buy over and mange the properties. Hopefully, we don't become the nasty and unscrupulous landlord who first chased us out. Or maybe we should all close our clinics and sell ice cream instead.

Sky High Rental at GP Clinic

32.8k a month! Wow, that is a lot more than the take home pay of most Singaporeans. No, I am not referring to the pay rise of Singaporeans. This is the monthly rent paid by a GP group to HDB in Ponggol. I often wonder how a GP clinic can bring in so much money a month. On top of this high rental, the clinic still needs to earn money to pay their staff, the doctors, the utilities, drugs, holding costs, wastage, practice insurance, etc. These days, when I pass by any GP clinic in the heartlands, I often see empty waiting area. Even though many of these clinics advertise cheap consult and as low as $10 for a short consultation, which is the price I cut my hair, they don't seem to bring in any people. Even with the revamped Community Health Assistance Scheme (CHAS) supposedly designed to attract the public to the private GPs, there is no notable change. Are Singaporeans so healthy that they do not need to see a doctor? Are the private GPs so expensive that the public cannot afford? Are our public institutions offering free or next to free quality healthcare that the private GP clinics are empty? So, how is a brand new GP clinic survive in a new town with rent as high as $32.8k a month when the private GP market is depressed? I am puzzled.