The deans of three medical schools in Singapore have called for more “generalists” rather than specialists.

The term “generalist” refers to practitioners who are skilled enough to treat a patient with several medical conditions, rather than referring the patient from doctor to doctor.

“Increasingly, I think that’s what we need in the health system ̶ we need generalists,” expressed Associate Professor Yeoh Khay Guan, who is dean of the Yong Loo Lin School of Medicine at the National University of Singapore (NUS).

“It’s not very good if our elderly patients see five doctors. It’s better if there’s also a generalist to look after their needs.”

Generalists can be argued to be similar to general practitioners. However, they need to be trained in family medicine, geriatric and palliative care, too.

Specialists can be potentially steered towards more general disciplines

This is in partial contrast to Health Minister Gan Kim Yong’s call for more specialists in geriatric medicine last October. He urged for 30,000 more healthcare workers to cater for the elderly community, mainly highly trained nurses and geriatricians.

Similarly, the Singapore Medical Council (SMC) has reported that niche fields, such as renal medicine and hand surgery, are among the disciplines with the biggest percentage growths – compared to palliative or geriatric care.

Nonetheless, they have also reported a potential growth for general disciplines, such as internal medicine, which saw a 50% increase between 2012 and last year. This general field of medicine focuses on treating a person as a whole, rather than focusing on a single organ or area, therefore needing to have a wide range of skills.

In the same period, the number of palliative-care doctors have also doubled, while the geriatric medicine specialists increased by a third.

Singapore is no doubt facing an ageing population with a predicted rise to 610,000 people aged above 65 by the year 2020, compared to 460,000 in 2015.

These generalists are necessary in an ageing population where many elderly people have multiple health problems, said Professor James Best, dean of Nanyang Technological University’s Lee Kong Chian School of Medicine.

“(It is) holistic medicine, where the doctor looks at the whole person ̶ not just his heart or his kidney,” he said. “We also need to consider the patient in the context of his family and society.”

Lack of appeal of the field discourages medical students

Yet, getting young doctors into these fields is not always easy. For instance, specialties such as surgery are often more lucrative, therefore making them an attractive option, remarked Dr Loke Wai Chiong, who is Deloitte South-east Asia’s healthcare sector leader.

Other specialties also have a better work-life balance, as there is no need to deal with extremely ill patients or emergencies. In addition, specialties like geriatrics and palliative medicine can also be viewed as ‘depressing’ as they deal with older patients, Dr Loke opined.

“(Some may) have many different diseases, all potentially exacerbating each other, with no chance of a complete cure,” he added.

According to a 1992 paper by researchers from the University of Texas Medical School, medical students also see generalist medicine as existing in a nebulous world of non-science. The scope of knowledge in generalist disciplines is broad and unbounded, that students feel that these fields cannot be approached with sufficient scientific rigour.

Possible solutions: Starting from medical school

Professor Thomas Coffman, dean of the Duke-NUS Medical School suggest that role models should be given to medical students to be emulated.

“As these specialties grow and as medical students see people working… they can see how compelling these areas are,” he said.

NUS on the other hand, has tweaked the curriculum to reflect the population’s needs.

“As the demographics change… we try and shift our curriculum towards those areas, to give (medical students) better coverage and more exposure,” explained Prof Yeoh.

This is also challenging as medical knowledge increase so rapidly. The current solution is to train students in the art of learning, rather than memorising facts, the deans said.

“If you’re a good doctor, you never stop learning,” asserted Prof Best. MIMS

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