"I prefer to keep them healthy than treat them when they are sick"

It is strange that I should be doing this on Christmas Day, but I am catching up on my readings.  Tasked with the charge to be the healthcare architect for the population in the west with the building of the new Jurong General Hospital, I have been populating and inspiring my mind with ideas others are thinking and implementing.

I picked up an email containing an article from one of the online issue of the NYTimes, "If all doctors had more time to listen".  Dr Batlle, a primary care doctor in the US was quoted in the article saying "I prefer to keep them (patients) healthy than  treat them when they are sick".  I thought to myself, this is indeed what Jurong Health Services - the health system comprising Jurong General Hospital, aspires to do for the population in the west.

The article started with a visit by Dr Batlle to the home of a 93-year old patient.  She had 15 types of medications from a range of healthcare providers including a cardiologist, gerontologist, a pulmonologist and upon checking, found that "...some of the medications have expired, some unnecessary and some dangerous if taken together".  Dr Batlle was able to cut her medication to 4 and gave the family her personal mobile phone number.  According to Dr Batlle, she was able to save the patients from several visits to the accident & emergency and hospital stays because she was able to attend to the needs of the patient in a timely manner.

I asked myself, "Is this a far-fetch example of badly coordinated care, or is this the real world out there where patients may unwittingly be left floundering?" Based on the experiences of my family members, feedback from patients that I have heard over the years, and some recent feedback from colleagues whose loved ones have taken ill (both locally and overseas) - this example represents a real need out there for better care coordination, better access to patient-centred care that will enable patients to manage their medical conditions or to just stay healthy.

Navigating healthcare for our own health can be quite daunting.  We lack knowledge of medicine and hence depend heavily on healthcare providers to guide us through the "healthcare maze" of:

- when should I go to the GP,
- when do we need specialist care,
- is this serious enough for us to head straight to the the accident and emergency department,
- is there a particular type of specialist I should see,
- if there are few specialists looking after me is there one overall in-charge who will know everything about my medical condition,
- my doctors who are seeing me for various conditions are giving me different medication - should I take all or discontinue some,
- when I am discharged from the hospital will I be able to take care of myself,
- how will I know if I have fully recovered,
- if I am referred to the community hospital will they know how to continue my care,
- which nursing home should I choose - are they all the same,
- how do I take care of my wound when I am discharged,
- why is the instruction from the discharge nurse different from the doctor - who should I follow,
- if I need help to manage my condition who should I ask,
- this medication makes me dizzy should I stop
...the list goes on.

It has become quite obvious that we need a better way to integrate care for our patients, hopefully even before they become a "patient".  The population will benefit when we are able to "stitch together" the various components of our healthcare system and make it easy for the man-in-the-street to be able to better access the right care.  In the first instance, we should make it easy for people to stay healthy or at least have the information so that they can be motivated to do so.

My dream is that we will be able to ultimately integrate healthcare in a manner so simple that we can literally "bring health to every home" - much like the simple but powerful Microsoft vision of "putting a PC on every desk running Microsoft".

IT will be a key enabler and work to put in place a national health record for Singapore has already started.  Healthcare capacities and capabilities will need to be enhanced, and the plan to build JGH is a testimony to that commitment.

Singaporeans can be proud of our healthcare system.  When compared to the healthcare systems of even many of the advanced countries in the world, ours continue to stand out in terms of quality, access and cost.  As our population continue to age and with the growing incidence of chronic illnesses, this transformation of our healthcare system that is currently taking place, from the current episodic acute care based approach to one that is integrated, seamless and population based will indeed be the change that we need.

Let's see how we can co-create a healthcare system that will truly put "Health" at the centre and NOT just "illness" care.