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Old 20-09-2022, 09:42 PM
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Originally Posted by Unregistered View Post
Noted recent threads.
Coming from a perspective of a junior FP (only cleared mmed last year). I think ops pts will get increasingly complex. After mmed, you tend to get arrowed to join various sag groups, where you work with specialist to design workflow/cpg etc.
In my opinion, with an aging population, there will be an increased demand in hospital services, and when hospitals cannot cope, they will try and decant their pts to us.

I forsee there will be more shared care pathways (e.g stable heart failure, COPD, ILD, wouldn't even surprise me if stable Ra pts may be decanted to us in the future), and more of the specialist drugs will be available in ops (e.g entresto, or certain dmards for RA, with specific workflow/cpg on how to manage these pts)
- they may also start decant pts earlier to us, e.g post pci for mi, cardio may just see once then decant to us, renal may only accept pts with ckd4 and above, meaning pts with ckd 3a/3b will be managed in ops. (I currently refer all ckd 3 and above to renal based on my institution cpg)

Gps are probably spared from this as they can always say I don't have these drugs, so I can't manage.

With the government grandplan for healthier sg, I forsee there will be increase demand in screening services which will likely be a huge source of income for gps.

Just my thoughts 😃
what u are talking is capitation my dear friend. It is not a good thing.

Anyway, not sure why u getting so excited with more work.
as it is , 10 minutes to handle a run of the mill DM, HTN, HLD patient already not enough time liao and now u talking about subspecialty care?

come i teach u how to write the sentence "DIE CORK STAND'

Anyway, share care is not easy la. Your RA share care already trial by prof Goh Lee Gan and Dr Anita Lim from NUH -> go search the paper. Not economically viable.

CKD quite common la -> many ESRF patient decline RRT dun want go back renal we see a lot what. Just very sian to do the full ABCDEF renal consult, write special bicarbonte order stuff , etc. Give me time i actually very happy to do it. At least not so boring. but I DONT HAVE TIME.

Piang ey. Dont get me started on screening services.
- today one lady bring in a 0.5 inch thick fodder from private healthcare screening package and hold and behold actually got a memo. I was initially quite stoke a GP actually write a memo. But then read liao write might as well don't write

54 year old lady. The letter goes..

1. BMD show osteopenia. Pls manage.

2. There is high cholesterol and fatty liver. pls manage

3. There is haematuria and oxlate crystals in urine. pls manage.

T score -1.1. Pls la , calculate a FRAX score at least. Why u even do a BMD in a low risk patient is beyond me but okay, u want money.
High cholesterol ? yea, the LDL is 2.8. High your head la
Fatty liver ? FIB 4 score low until cannot low . Ask her to lose weight la
hematuria -> hello repeat UFEME la.

Bloody brainless, this screening GP essential just copy part of the report that is red into a memo and write ' pls manage after it'

After going through the above, the lady want me to explain the entire health screening booklet to her.

I tell her no way in hell politely.

Healthier SG will just result in more of the above coming into polyclinic. The private sector reaps the financial benefits selling expensive packages , hire a bunch of brainless GPs / or GPs who can't be bothered but very nice smile smile and transfer the entire burden of doing unnecessary test into the public sector.
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