By: Kang Yi Xi (15S03N), Nicolas Baey (15S03F), Louisa Li (16A13A), Huang Jiawen (16S06G)
When Dr Chan Kin Ming (RI, 1975) was just a newly minted house officer, he received a request from Dr Ho Tat Kin, the MP of Boon Teck Constituency then. The job? To take care of the healthcare needs of a group of very poor, home-bound elderly people living in the constituency. Upon hearing about their plight, Dr Chan, who had always harboured a passion for community service, readily agreed.
Twice every week, for a whole decade, he would pick up his doctor’s bag and head down to the houses that had been identified. Dr. Ho’s request may now seem minor in the whole scheme of things, but our country would be a markedly different place had Dr Chan declined that request so many years ago. After witnessing first-hand the medical issues and sordid living conditions the elderly had to grapple with, Dr Chan became utterly convinced of the need for a healthcare system that could provide proper support for the aged, and spent the rest of his life spearheading major developments in our local geriatrics sector.
Having obtained his Masters of Medicine in 1988 and his Diploma in Geriatric Medicine in 1991, he set up Singapore’s very first Geriatric Centre in Alexandra Hospital soon after, at a time when few even had the foresight to be contemplating the challenges a rapidly ageing population would bring to our society. Even to this day, Dr Chan’s critical examination of the problems faced by the current pioneer generation offers a fresh insight into the future outlook of Singapore’s healthcare sector.
The Early Years
Many aspiring doctors will say that entering the medical profession has been a lifelong dream of theirs, and one may expect that someone as dedicated to his work as Dr Chan would have been passionate about medicine since a young age. Surprisingly, Dr Chan had actually aspired to become an accountant during his adolescent years, and the reason behind his change of heart was closely tied to a tragic personal event. When Dr Chan’s father was 55 years old, he was abruptly struck by a sudden bout of illness and passed away. That incident left an indelible imprint on the young Dr Chan’s mind, and his grief spurred him to switch courses and consider going into medicine. Smiling ruefully, Dr Chan commented that a ‘teenager’s way of thinking’ underpinned the motivation behind his career choice – the youthful always think that they can save the world.
Never the athletic type, Dr Chan, a student in the pure science stream, preferred to spend his days in RI reading and studying in the library. Though he joined the Red Cross Youth Chapter from Secondary 1 – 4 and won several first aid competitions, he jokingly admitted that he chafed under his experience in the CCA as ‘marching under the hot sun wasn’t my thing … but they were kind enough to let me stay on to accumulate my 2 points’.
Finding his time in the Maths and Science Society to have been much more fulfilling, Dr Chan fondly recounted how even he was prone to engaging in youthful shenanigans – all in the spirit of scientific inquiry, of course. While working on a project on ants together with his Pre-U1 seniors (Year 5 students) when he was in Secondary 4, he and his mischievous peers trespassed on a church’s grounds to steal a weaver ants’ nest for their project, and ended up being caught red-handed by the pastor. Fortunately, they were forgiven, and the boys’ efforts eventually paid off – their project won a national level science award and was even exhibited at the Science Centre.
Life as a Geriatrician
Dr Chan started off by debunking one common misconception people have of geriatrics: ‘People equate geriatric medicine with longevity, but that’s nothing further from the truth. We’re more interested in quality of life.’ True to that maxim, a geriatrician’s scope of responsibility should extend beyond mere diagnosis and prescription – Dr Chan strongly feels that practitioners in this field should worry about their patients’ nutrition, living environment and caregivers as well, in order to deliver holistic and effective treatment. ‘The health of the individual is also dependent on the environment,’ he shared, recounting how he has helped manage his patients’ bedbug and cockroach infestation problems, and how he has even provided emotional support for his patients’ caregivers. One can see from Dr Chan’s actions that he cares for his patients above and beyond what his profession mandates, and if that is not the hallmark of a truly noble medical practitioner, then what is?
Engaging in a fair bit of detective work is also part and parcel of a geriatrician’s job, perhaps more so than for doctors working in other areas of specialization. For one, a geriatrician usually does not know what his or her patients’ problems are on first sight, since geriatrics deals with a broad spectrum of medical disorders, running the gamut from dementia to skin problems. ‘It’s not like being a cardiologist – when anyone that walks through your door, he definitely has some sort of heart problem,’ Dr Chan candidly remarked.
In fact, this particular aspect of geriatrics has fuelled his passion in the field all these years. He advises doctors-to-be to always demonstrate a spirit of inquiry, even for seemingly mundane and trivial incidents. ‘When you find a diagnosis that no one has found before, you will feel so happy – as if you have won the lottery!’ he chuckled, bringing up an example of a perplexing case he once had to deal with. ‘When I was in the UK, we had a patient who got admitted every winter. The diagnosis was that her platelet count was low, but after staying in the ward for a few days, her platelet count would return back to normal … (After doing some research), I found out that there was a condition called hypothermia-induced thrombocytopenia … This person was actually quite poor and didn’t have a heater. So when she was at home, she got cold and her platelet count dropped. But when she was in the hospital, her platelet count rose since it was warm,’ he recalled.
However, despite the diversity of cases a geriatrician can be exposed to, and despite a greater recognition of the importance of geriatric medicine in Singapore, many young doctors continue to be deterred from taking up a career in geriatric medicine. This is partly because, as Dr Chan frankly disclosed, ‘working in this particular field demands a lot of patience’. Often, his patients take an awfully long time to even walk through the door and sit down; how many energetic doctors fresh out of the drudgery of medical school will be willing to consider specialising in such a seemingly tiresome line of work?
To make matters more complicated, there are bound to be a few elderly patients who deliberately ignore the instructions given by their doctors and opt to follow old folks’ wisdom. Dr Chan recounted how his patients are often tempted to take traditional remedies that have been touted as miracle cures, even though they may contain dangerously high levels of substances like arsenic. Acknowledging that he is unable to forcefully impose his mindset upon his patients, Dr Chan tries to persuade them using an empathetic approach instead, ‘through issues that are important to them, rather than things that are important to me’. For example, when treating patients who are developing dementia but refuse to take any medicine, he will tell them that they will eventually be unable to recognize their grandsons – this generally ends up being successful.
Perhaps one of the toughest moments in a doctor’s life will be that of watching a patient succumb to their illness, despite all that has been done to save them. ‘As a House Officer, I actually cried when a patient died,’ Dr Chan admitted. One can imagine how hard it can be for geriatricians like Dr Chan, who frequently deal with terminally ill patients and often have no choice but to watch their charges’ mental and physical faculties be eroded away by the insidious tendrils of disease. Indeed, coping with the stress of always having someone else’s life in your hands requires an astonishing amount of emotional fortitude, as well as a touch of sober rationality. ‘We have to be objective … Ultimately, we are not God: we may give the best treatment to our patients, but the outcome cannot be guaranteed,’ Dr Chan said, describing how he does his best not to let past disappointments weigh him down, so as to prevent his judgement for subsequent patients from being impaired.
Coping with our Greying Population
The fruits of Dr Chan’s efforts are evident: although Singapore is currently going through a difficult period of demographic transition, we are fortunate to have a relatively robust geriatrics field, enabling many elderly patients to age comfortably and the nation to be equipped with a variety of resources needed to deal with the needs of its ageing population. And progress is continuing to be made – just last year, Tan Tock Seng Hospital opened a sophisticated geriatric medicine centre outfitted with elder-friendly facilities like a ‘sensory garden’ with plants and chirping birds.
Dr Chan feels our current healthcare system is praiseworthy in that it offers adequate financial support for elderly patients in need. ‘I think we are very lucky as no one who needs medical help has been denied of it … Even though the treatment is costly, we never talk about it – if a patient needs treatment, we will administer the necessary treatment,’ he related, speaking from the perspective of a veteran practitioner in various local hospitals.
Yet, significant problems do remain: not many people have access to geriatric care because there are too few of such centers. ‘In some hospitals the waiting time is 4-6 months, but an older person can’t wait that long,’ Dr Chan lamented, adding that ‘it’s important that we continue with training healthcare workers and building resources if we wish to cope with the rapidly ageing population’.
Looking towards the future, Dr Chan was quick to highlight that despite promising technological advances in areas such as pharmaceuticals and telemedicine (the use of telecommunication technologies to deliver health care services remotely), ‘there’s still nothing that can help with the emotional problems faced by the elderly’. His concerns strike home: in recent years, faced with a hectic working lifestyle and a lack of time to dedicate to caregiving, many Singaporeans have resorted to sending their elderly parents to old folks’ homes, some even in far-flung, lower-cost locations like Malaysia.
Dr Chan warned against the aforementioned trend, saying, ‘This has been thought of purely from the point of view of money, but I think human lives and relationships are worth more than that.’ He grimly pointed out that such outsourced care could lead to a situation in which the elderly lack warmth, love and fulfilling relationships, but is uncertain about how the problem can be addressed; in his view, the issue can truly be solved only if ‘we go back to the time where every family has many children, and one of the children will just not work and look after the parents … This isn’t possible in the current world’. Of course, there are still steps our society can take to alleviate the issue, and Dr Chan shared how Thye Hwa Kwan Hospital (of which he is the Chairman) actively engages volunteers to ensure that its patients, who would otherwise be living their lives ‘by a robotic and mundane routine’, would always have someone to interact with.
A Noble Profession
When asked what words he had for Rafflesians thinking about a career in medicine, Dr Chan wisely provided some tried and true advice: ‘If you want to be rich, don’t be a doctor … You should only do medicine if you have the passion for it.’ He shared that the glamour of the job and the experience of being under the limelight will inevitably fade, and it will really come down to having that passion to help others – seeing every patient will then be like a challenge to you, and you will always wonder what you can do to make your patients’ lives better. Ever the humble practitioner, Dr Chan feels that at the end of the day, ‘it’s alright if I don’t make any noteworthy discoveries, as long as my patients have benefited. That is where I derive my satisfaction from’.
Indeed, Dr Chan’s compassionate nature and dedication to his work are qualities all of us should look towards for inspiration, no matter our career path in the future. Coping with the impact of an ageing population requires the concerted efforts of our society as a whole – as Dr Chan highlighted earlier, there is only so much technology can accomplish, and many of the elderly currently face a dearth of emotional support. We can start by developing a sense of empathy for the aged around us – by volunteering at old folks’ homes, conversing more frequently with our grandparents, and simply taking the time to care for our parents when they themselves grow old. After all, without the tireless efforts of these people, our nation would not be the bustling city-state it is today, nor would we be the people whom we are. As Dr Chan said with a touch of optimism, ‘Hopefully, if everyone puts in effort towards encouraging the human heart, there will be a greater impact.’