Family Medicine and Singapore
Modern-day Family Medicine began as a “counterculture” to the disease-and-body-part focus of the hospital specialities in the 1960s. The ethos of social reforms in this period touched the field of medical practice also leading to an era of renaissance for the age-old discipline of General Practice. Uninhibited access to medical care for everybody, especially the medically underserved, personal, and family-orientated care on a continuing basis, and comprehensive care at a reasonable cost were crucial in the modern rise of family practice.
Singapore followed the global paradigm that emphasized: “Physicians practising Family Medicine required vocational training for several years.” Translating the Family Medicine “counter-culture” vision into various educational programs has been a huge challenge worldwide as well as in Singapore. Over the years, the specialty of Family Medicine evolved in Singapore at a steady pace to become the core of healthcare services attracting some of the best talents to the specialty.
Evolution of Modern Health Services in Singapore
To begin with, it is prudent to chart the origin and evolution of the subsidized polyclinic system that has over the years maintained its place as the core of primary health care in Singapore. The history of modern medical care in Singapore began in the year 1819 with the arrival of Sir Stamford Raffles in Singapore. Accompanying him was Thomas Pendergast a Sub-Assistant Surgeon who introduced western medicine to Singapore.
In the year 1821, the first General Hospital was built. However, it was in 1888, that the first midwife was trained and in 1907 Maternal and Child Health services were introduced in Singapore. The fall of Singapore to the Japanese army in 1942 signaled the dark days and health care services came to a standstill leaving behind an extremely malnourished disease-stricken population (malaria and beriberi were common) till the British war administration took over in 1946.
For the new administration, it was essential to provide expedient medical care for the famished people and also draw a comprehensive medical plan for the development and upgrading of services.
1947 and Beyond
The ideology of the founders was envisaged in the golden words of the chief architect of medical plan of 1947, Dr. WJ Vickers the then Director of Medical Services who said, “It is stated that one-fifth of the population of Singapore is in the nature of a floating surplus and there is no need for this colony to bear medical costs in this connection. Such a view cannot be accepted by any responsible authority. Common humanity and expediency demand that the poor man must be dealt with medically whether he is within our gates for 10 weeks or 10 years.”
However, the capitalist culture that has given an industrial colour to health care has abetted the modern-day governments to conveniently overlook this philosophy and today Polyclinics are out of reach from the poorest of the masses, i.e., the foreign domestic help and migrant workers from Asian countries who form the backbone of Singapore’s construction, hospitality, healthcare, and other support services.
Beginning in 1947, the Maternal and Child Health became the most important campaign in public health and by 1950 the 10-year medical plan was in motion with the initiation of immunization and a drive to administer vaccines against smallpox. In 1949 was established the registration and regulation of the nursing profession, domiciliary antenatal care was introduced in 1952, and from 1953 midwives began to be trained in antenatal and postnatal care. Rural health centres were opened at different locations and public health campaign was intensified.
In the year 1970, laboratory facilities were added to outpatient clinics, and in 1976, the Public Healthcare division. Outpatient services, maternal and child health services, and school health services were brought together under this division. The 1980s and 1990s saw consolidation of the outpatient services and maternal/child health services into 16 polyclinics distributed throughout this island state. More services like X-ray, mammogram, physiotherapy/podiatry, Dental, etc., were added to the polyclinics.
Family Physician services were introduced to address the needs of those with chronic conditions and those with special care needs. The growth in infrastructure was in tune with the growing healthcare needs especially to address the increase in complicated needs of individuals with multiple co-morbidities of chronic nature. This required an equivalent enhancement of the clinical capabilities of the General Practitioners who formed the core group of primary health care providers in the public and private practice.
This felt the need was suitably catered by the advancement of the speciality of Family Medicine with tailor-made programs for primary care physicians at various levels of training and practice.
Defining Family Medicine in the Singapore Context
The College of Family Physicians Singapore defines a Family Physician as a registered medical practitioner who has acquired core competencies in clinical care, Person-centered care, comprehensive and continuing care, collaborative and integrated care, community-orientated care, and a commitment to professional care based on ethical principles.
Defining Family Medicine in the Singapore Context
In the context of Singapore, family physicians provide general medical care of patients in the following practice settings:
- Private sector primary care clinics (GP clinics)
- Public sector primary care clinics (polyclinics)
- Community hospitals
- Restructured and private hospitals
- Other intermediate and long-term care facilities (home medical care, hospice, and nursing homes)
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