With more than 30 years of experience in general practice and primary care research under her belt, the first full professor in the Division of Family Medicine – Professor Doris Young – has her mind set on improving the family medicine curriculum at NUS Medicine, in line with Singapore’s new focus on primary care.

Prof Young, who joined NUS Medicine in January 2017, plans to augment the small Family Medicine division by tapping on the expertise of practising family physicians to share their practical experiences through case discussions tutorials. In Prof Young’s opinion, the current curriculum is too hospital-centric and not ideal for the training of family doctors. She believes that having more family medicine or primary care-centric case discussions could help to fill this gap.

“What would be the family doctor’s role in managing diabetes better? What would be the family doctor’s role in managing depression? We should pursue it through the eyes of a family doctor, not through the eyes of a hospital specialist. Because if you have too many hospital specialists teaching our Family Medicine residents, they will focus on the diseases seen and managed in the hospitals, rather than those problems seen and managed by doctors working in the community. Family doctors need a different kind of skills. I want it (this set of skills) more embedded in the curriculum,” said Prof Young.

Patients in the community stem from different ethnic groups, backgrounds and economic status, and they may be dealing with other health problems apart from diabetes.

“As a family doctor, we need to look after this patient as a whole person. Instead of just biological, there is also the psychological aspect and social issues to deal with for having diabetes. As a good family doctor, we know this person over time. We know their stresses in life and the way they perceive and cope with illnesses,” she said.

Prof Young, who is also the Associate Dean for the China Programmes at the Faculty of Medicine, Dentistry and Health Sciences at University of Melbourne, believes that practitioners such as herself should go beyond imparting their practical knowledge to students and residents but also seek to inspire them as academic role models. She aims to share her career and life journey with the students in a bid to inspire them to take up academic family medicine as a career choice.

“The young doctors here need to see a role model, to see this is what a Professor of Family Medicine looks like — the teaching and research skills needed and the career paths taken to achieve that. Hopefully I could instill that passion in the next generation. And I would need to engage the whole Family Medicine community to work together,” she said.

Another area Prof Young wants to focus her energy on is birthing a new research culture on topical general practice-related research that the country needs. Prof Young, who was responsible for strengthening Australia and Hong Kong’s primary care research, believes that more research in family medicine would greatly complement Singapore’s family medicine's academic standing.

“I want to call on all the family doctors here, those working in the polyclinics, Family Medicine Centres (FMC), private practices to form a primary care research network and say to them, let us all unite with nurses and allied health and build a research culture in family medicine in the primary care setting. We can do it. Research is not all just about dealing with animals, DNA, or laboratory-based research, there is good research that can be done in Family Medicine and primary care,” Prof Young said.

To build a research culture centred in family medicine, Prof Young said NUS Family Medicine should collaborate with established researchers from other Schools, such as 

the Saw Swee Hock School of Public Health; specialists such as endocrinologists, psychiatrists and psychologists, and help to translate and implement their research into the wider community.

Prof Young’s work does not just end in Singapore, she aims to link the local researchers with her global contacts to further research. She said more international collaborative research in the areas of chronic diseases, multi-morbidities, aged care, mental health and the global problem of antibiotics resistance would benefit Singapore.

“I (plan) to instill a research culture amongst the existing staff here, the medical students, residents, and the general practitioners out there. A lot of them are already doing good research work in their polyclinics. I want to link them up with the team here, and with my colleagues at the University of Melbourne, and internationally with other family medicine researchers, so that the younger doctors may follow,” she said.

Having worked as a general practitioner in countries with strong primary care systems such as Australia and the United Kingdom, Prof Young believes Singapore still has a bit to catch up on in terms of strengthening its primary care sector and changing public perception of family physicians. The family doctor-patient relationship and trust appears to be weaker in Singapore than abroad.

“An efficient healthcare system usually has a very strong primary care system. The respect from the public is very important, that every person or family should have a family doctor. In Australia, 90% of the people have a general practitioner. In the UK, it is 100%. In Singapore, many people head to the hospitals when they are ill. There isn’t enough of a one-to-one (family doctor-patient) relationship here yet,” Prof Young said.

Easing the unnecessary burden on Singapore hospitals and inculcating a “cradle-to-grave” mindset among the healthcare users would require government campaigns and media support.

“I think it would work through a multi-pronged approach, through the media to stress the importance of having a family doctor… and to strengthen the Division of Family Medicine by giving it appropriate resources, working with current practising family doctors, and bringing them together to share a common vision of family medicine in Singapore. Hopefully, the leadership here in NUS Medicine would show by example by building a strong academic department of Family Medicine,” said Prof Young.

Family doctors and patients would also need to do their part. Doctors should upskill to maintain or regain public trust in their skillsets and expertise, Prof Young said. The public would need to trust their family doctors to diagnose and manage their problems.

Despite these challenges, Prof Young pointed out that Singapore has begun to place more emphasis on strengthening its primary care system.

“The timing is right. There is the primary care movement supported by the ministry; there is recognition of family medicine as an academic discipline. There is a lot of curriculum time now in NUS Medicine and the Lee Kong Chian School of Medicine, and we just need to enhance it.”

During her time at NUS Medicine, Prof Young hopes to be able to establish a self-sustaining ecosystem for the Family Medicine Division.

“I hope to share my passion and enthusiasm for academic family medicine, and instill that in some of the young medical students and residents, so that I can leave behind and make some impact on the academic discipline of family medicine in Singapore, which will be sustainable for others to make their own mark on the future of the discipline.”