Better care, fewer check-ups: Patient, 91, benefits from one doctor managing hospital care
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Mr Osman Abdollah, 91, with his doctor Neeta Kesu Belani (left) and daughter Hadijah.
ST PHOTO: JASON QUAH
Follow topic:
- Mr Osman, with multiple conditions, benefited from Alexandra Hospital's care model of having one principal doctor coordinate his treatment, avoiding numerous specialist appointments.
- This has helped to ease his daughter's caregiving burden. Dr Neeta Kesu Belani has also discussed end-of-life care with Mr. Osman, highlighting a holistic approach to patient management.
- The Ministry of Health aims for public hospitals to adopt this consolidated care model to address the complex healthcare needs of Singapore's ageing population effectively.
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SINGAPORE – Mr Osman Abdollah, 91, who previously underwent heart bypass surgery and has multiple health conditions, including diabetic kidney disease and hypertension, used to shuttle between different hospitals and polyclinics for his check-ups.
A wheelchair user, he mostly depends on his daughter to accompany him and would sometimes miss his appointments.
In October 2024, he sought help at a polyclinic due to breathlessness and was referred to Alexandra Hospital (AH) for further tests.
He consulted senior hospital clinician and principal doctor Neeta Kesu Belani. After examining him, she found that his legs were swollen and in fluid overload. She then diagnosed that the breathlessness was caused by too much fluid in his body.
To help reduce the excess fluid, she adjusted his heart medication, advised him to drink less water, and go on a low-sodium diet to limit water retention.
A follow-up visit was arranged so that she could monitor his progress. During that period, she also noticed that his blood sugar level was low, and she adjusted the dosage of his medication.
In 2018, AH piloted this model of consolidating the care of patients with multiple conditions under one principal doctor, instead of having the conditions managed separately by several specialists.
The hospital’s medical board chairman Khoo See Meng said that because the model requires doctors who are skilled in this mode of care delivery, they started recruiting and training hospital clinicians like Dr Neeta, who later became the principal doctor for many of her patients.
Hospital clinicians are trained in broad-based care to effectively coordinate and deliver care across different settings. Complex cases will be referred to specialists.
On Sept 20, the Ministry of Health said it was enhancing the hospital clinician career pathway to support public hospitals
If AH did not have this care model, Mr Osman might have seen a kidney specialist first because he has diabetic kidney disease, Dr Neeta said.
To fix his fluid overload issue, he would have been sent to the emergency department to be admitted so that doctors could investigate and treat it.
Upon his hospital discharge, he would have been given an appointment with a heart specialist, who can titrate his medications to manage the fluid overload, she added.
Under Dr Neeta’s care, Mr Osman managed to reduce his hospital visits, which made him happy, said his 59-year-old daughter Hadijah.
“It really lifted the (caregiving) burden from my shoulders,” added the administrative executive.
When there are check-ups, she has to take leave and travel back and forth between her home in the east, her father’s place in the west, and the hospital.
In the beginning, however, the family was not comfortable with the care model.
“When we met Dr Neeta, she told us that we can just see her (one doctor) at one hospital. We were quite sceptical initially,” said Ms Hadijah.
They asked Dr Neeta: “You mean we don’t need to take him to Ng Teng Fong General Hospital for his heart appointments and NUH (National University Hospital) for his diabetes checks?”
But they soon found that they could trust Dr Neeta.
As she could converse in Malay with Mr Osman, he took to her in no time, allowing her to broach the topic of end-of-life care when he became very ill at one point, said the doctor.
Dr Neeta attended a two-year hospital clinician training programme instead of a much longer residency programme because she wanted to spend time with her two young children.
“We need doctors who are jacks of all trades,” she said.
This is particularly important in ageing Singapore. As the health conditions of older persons increase, it can become impractical to consult multiple specialists for every ailment, noted Dr Neeta.
“Many people want to see the best specialists for a specific condition... but managing a plethora of appointments for numerous conditions is overwhelming. This is especially true for older patients,” she said.
“If you have 10 conditions and 10 different doctors to see at three-month intervals, it will be exhausting to manage. It creates a burden not only on the patient, but also on the caregivers as well, having to juggle multiple appointments across different departments or even hospitals.”
Principal doctors coordinated care across acute and rehab phases, even for non-clinical social needs
Over at Woodlands Health (WH), the role that a principal doctor can play was accentuated through how Mr Mak Kok Meng’s needs were taken care of in his recovery process.
Mr Mak, 56, had a fall at home on July 6 and was admitted to WH.
The principal doctor who attended to him assessed his condition and ordered that he undergo a magnetic resonance imaging scan, which showed that he required specialised neurosurgical care for a spinal nerve compression.
The principal doctor then arranged for Mr Mak to have a consultation with a WH neurologist.
As Mr Mak was assessed to face a higher risk of complications from a spine surgery, he was advised to lose weight before reassessment. He has since shed 10kg and now weighs 140kg, though he is still far from the target of 90kg.
After two weeks in the acute ward, Mr Mak was transferred to a rehab ward to be cared for by physiotherapists and occupational therapists, but this was similarly coordinated by another WH principal doctor in the rehab ward.
Upon Mr Mak’s request, the principal doctor also roped in a medical social worker to help him with his non-medical needs, including applying for MediFund support and other financial aid, as he was no longer able to work as a security officer due to weakness in his legs. Mr Mak was discharged on Aug 24.
He appreciates how medical information was communicated clearly to him. “I am thankful that the principal doctors and the various care team members could always be readily available for me to reach out if I had any concerns about my care plan,” he added.
