Proposal Background Draft 1

World Class Healthcare

According to the most recent World Health Report on healthcare systems, Singapore boasts of the best healthcare system in Asia, being ranked 6th out of 191 countries (World Health Organization, 2000). In order to maintain the high standards of medical care, it is vital to constantly develop new medical talents. As a premium institution with an internationally recognized undergraduate medical programme, the Yong Loo Lin School of Medicine in the National University of Singapore (NUS) is dedicated to moulding our future physicians into competent individuals. Graduates of the medical programme enter the workplace as general practitioners, although some eventually choose to specialize. General practitioners are physicians whose practice is not skewed towards a particular medical speciality and “accept all patients regardless of the age, sex or the nature of the problems” (Ratnam, 1992). Due to the diverse nature of their patients, it is critical that general practitioners are well-equipped with effective communication skills. For the purpose of this proposal, the terms doctor and physician will be used synonymously with the term general practitioner.

Background

Dr Michael Balint, one of the most distinguished medical figures of the 20th century, once challenged the medical community with the bold statement “the doctor is the drug” (Balint, 1957). Although the therapeutic power of the physician-patient relationship has long been well-documented and studied since the time of the Greeks, it was Balint who first contextualized it to the medical field of general practice.

One literature review observed that the physician-patient relationship is possibly one of the most intricate relationships (Ong et al., 1995). Not only does it involve 2 persons of unequal positions, it is usually obligatory and associated with issues with potentially significant implications. These factors contribute to an emotionally laden relationship that calls for mutual understanding. Thus in spite of advancements in medical technology, which has translated to more effective diagnosis and treatment methods, inter-personal communication remains the principal instrument by which the doctor and patient exchange information (Street, 1991).

The Yong Loo Lin School of Medicine recognizes the importance of communication in the doctor-patient relationship. 2 years ago, it introduced the Patient-Based Programme as part of its integrated 5-year medical curriculum. However, little is known about the programme due to privacy issues. Being in its infancy stage, the programme is constantly being reviewed and improved upon. A preliminary survey conducted by this team on current NUS medical students in the programme revealed that there are one or two lectures on effective communication and approximately 3 clinical sessions dedicated for teaching effective communication. During these sessions, the doctors will instruct the students the technique of initiating conversations and importance of communication for effective diagnosis.

However, despite the introduction of the Patient-Based Programme, some may argue that the efforts to impart effective inter-personal skills might be negated by the already highly demanding medical curriculum. Given the time constraints of 2 lectures and 3 clinical sessions, it would be difficult to effectively impart communication skills. If medical students are poorly equipped with communication skills, a potential source of concern arises when they graduate and enter the workplace.

It is apparent that ineffective communication skills in the medical workplace may have potentially adverse consequences. The Consumer Reports National Research Centre’s survey of 39,090 patients reported that despite a large majority of patients being satisfied with their doctors, 31% of patients indicated that their physicians did not discuss the side effects of the prescribed drugs (Consumer Union, 2007). 9% of patients also mentioned that their physicians failed to review their other prescriptions to prevent any potential drug interactions. This raises the possibility of injury or even death due to a serious reaction to a prescribed drug or drug-drug interaction. Even more compelling evidence came from the Joint Commission on Accreditation of Healthcare Organizations (JCHAO) which cited communication problems to be the most common root cause of sentinel events across medical disciplines from 1995 to 2006 (Joint Commissions, 2007). Sentinel events are “unexpected occurrences involving death or serious physical or psychological injury, or the risk thereof”. Thus it is evident that effective communication could play a preventive role in these sentinel events.

Furthermore, from the Consumer Reports National Research Centre’s survey, it was found that two-thirds of the patients said that they were not told by the doctors about the costs of treatments and tests (Consumer Union, 2007). Whatever the reason for the apparent lack of transparency, it is likely that more effective inter-personal communication would improve the physician-patient relationship.