Quote:
Originally Posted by Unregistered
it is probably difficult to mimic a GP centric medical environment like Australia in Singapore, as specialists are definitely more accessible in comparison. The current climate of practice in Singapore also seem to encourage defensive medicine, with primary care physicians clogging up the emergency departments and specialist outpatient clinics with tons of referrals that may not be necessarily indicated.
It is unfair to point fingers as well, why would GPs manage or follow up these patients when they already have individual queues of 50-60 patients in the polyclinics every day. The role of the GP as the 'gate keeping physician' in the community seem to have been diluted to be more of a 'post man'- filtering undifferentiated presentations and directing them to the relevant specialties. Perhaps a better solution is to encourage the rise of middle grades such as advanced nurse practitioners/nurse clinicians that can assist in the care of stable chronic patients in the community to share a part of the load.
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U student writing essays ah.
Aiyah. APN , care managers exist liao. Doesn't work, still a doctor centric care model. Anything complicated they ask me still, Medicine I got to prescribed also, MC also I write. I explained the decision logic to them, next time asked me still. End up i see the patient better and faster. Anything wrong also my own fault. When they see , sometimes they tell u a half f picture , u ok their plan but actually they screw up but just cos they put discuss with Dr xzzz, it becomes Ur responsibilities.
They are useful for a very small subset of stable patient, like hyperlipidemia stable for the last 10 years that kind, htn on amlodipine 2.5mg that kind.
Sometime I slot in stable chronic for myself so I can take a breather. Whole day see double digits hba1c cases very headache. APN thst can prescribe are few. Most dun want to take up that license also , do doctor work dun get doctor pay..why bother.
So no Ur thesis is useless.
Polyclinic work is actually challenging and a hospital trained m.med fp can actually treat and manage a lot of things. I can manage female incontinence all the way short of operating on them for example , I can even do a pipelle if needed if a women comes in with post menopausal bleeding. Deliver babies also no problem. Toe nail avulsion, joint injection , plaster and cast etc all no problem..perhaps a bit rusty nia. I even learned how to do a cystoscopy so if u give me access to CT urogram, I can actually clear asymptomatic microscopic haematuria myself.
Referral occurs usually due to patienrt request or becuase some useless RP has no ****ing idea what to do...or simply doesn't care. Unfortunately back when poly wasn't a posting of choice, they took in a fair bit of pinoy , Malaysian and India doc that aren't exactly v good. Now can't fire them and the system has to live with their inadequacies.