Forum: Focus on sick person’s problems, not just diagnosis, Forum News & Top Stories

Health Minister Ong Ye Kung reiterated the three approaches to controlling healthcare costs – moving “beyond quality to value”, “beyond hospital to community” and “beyond healthcare to health” (Expanded community care to keep health costs down, May 30).

Possibly embedded within these approaches but important to make explicit is the view of moving “beyond disease to person-focused care”.

We need healthcare providers to keep an eye not only on cost but also on the care people truly need.

Person-focused care is provided to an individual over time (rather than through disparate single visits), to manage particular diseases.

It requires adequate recognition of health problems experienced by people.

Care is better when it recognises what a patient’s problems are, rather than just what his diagnosis is, whether it is Alzheimer’s or coronary heart disease.

“Beyond quality to value” becomes more meaningful when “value” considers what is important to people with health problems.

For example, when we go beyond seeing dementia as a cognitive deficit to a shift in the way a person experiences his environment, we look beyond deficits, and instead focus on what people value – optimising human potential and well-being, despite reduced functional ability.

Person-focused care emphasises relationships over time, views diseases as interrelated occurrences, and considers morbidity as combinations of types of illnesses.

For a physician and patient to work together to reach mutual decisions, a longstanding relationship is needed.

Patients are more likely to follow medication and lifestyle prescriptions if they share their healthcare practitioner’s belief about the causes of health outcomes.

This view aligns with going “beyond hospital to community”, where family physicians or community care workers know a patient and his family.

Innovations and enhancements to primary healthcare can further improve person-focused care.

Person-focused care considers the person’s experiences with health throughout his life, and how these experiences and the diseases evolve.

This view is aligned with going “beyond healthcare to health”, where the emphasis should be on the health of the whole population and one’s health over the course of life.

Such a life-course approach to health identifies the underlying biological, behavioural and psychosocial processes that operate across the lifespan.

This is even more important now as we have longer life expectancy, and want to maintain the highest-possible level of functional capacity for as long as we can.

Person-focused care has become more acutely needed with the Covid-19 pandemic.

We are heartened to hear of the kindness of healthcare and other workers who help others, even as their faces remain unseen.

It is person-focused care that brings out the much-needed human connection and solidarity in the midst of social distancing and uncertainty.

Wee Shiou Liang (Dr)

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