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Old 10-08-2021, 07:40 AM
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Originally Posted by Unregistered View Post
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I do feel that Singapore GPs/FM are less skilled compared to our overseas counterpart, mainly due to the geography and structure of our healthcare landscape. (disclaimer: I am a local grad, currently FM resident, that has never been trained overseas.)
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The Biggest reasons for this in my opinion is the ease of accessibility to tertiary care in the local context
- For e.g
> which GP in Singapore will deliver a baby when the tertiary obstetric centers (NUH/KKH) are at most 30 min away
> even for simple surgical procedures like abscess/removal of lumps, most GPs dont do it (I know some do, but most, esp those in OPS dont and simply refer them on)
> I mean we are all taught how to perform delivery (of babies) and I&D during residency training, but if you don't practice it, you will become deskilled eventually.
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- There is also a tendency to over refer patients.
I mean when I was running clinics during my rotations in ortho, ED, I do encounter many referrals which are inappropriate in my opinion
- For e.g referring asymptomatic patients with BP of 170-180 systolic or BSL of 18 (when it is measured post prandial) to ED
- Referring patients with mild OA knees/2 week history of back pain (with no radiculopathy) to Ortho (Hip/knee and spine respectively)
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Of course there are also other reasons in play such as
- the nature of our patients in general (most of them do tend to prefer consulting specialists/hospital based care)
- the structure of our healthcare funding system
> most people prefers inpatient care as they can utilize their medisave. (There is a cap on medisave use for outpatient care)
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I dont think our residency program is bad, but I do feel that there is a limit to what GPs can do in singapore.
I personally dream to practice FM in a different country (preferably in rural town) but unfortunately impossible nowadays due to covid situation
If u are local trained then u know the reason for the referral are

1. Patient wants it
2. For a lot of junior non trained Dr, esp those cmi rp from India, Philippines, it's easier to refer because that's the easiest thing to do Vs say, full examination, teaching self physio, explaining analgesia regime, activity moderation to the patient and then still them saying they want a referral for standby at the end.
As a resident unfortunately u have to do the full works for learning purpose. As a trained FM, I ask them quite upfront how I can help them..do you

A. Want 2 days to rest
B. Want a referral or X ray
C. Want me to manage you.

Delivering babies? When obgyn are running away from it due to the the malpractice no tail end cover situation , u as a gp want to deliver babies? Sure.

The fact of it is that gp help patient navigate the healthcare system and provide a lot of reassurance. The sooner you come to terms with it, the easier it is for you to like your job. The reality is as a gp ur skillset is flexible enough to cover a lot of ground if patient lets u. If not, move on and refer.
What you like, u can actually find in the setting of a&e. U can try NZ where urgent care is actually a speciality too.

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