Singapore's move to ensure palliative care isn't disrupted for patients is financially sound: American expert

Ensuring continued palliative care is not disrupted is the wise thing to do, said prominent palliative care expert B. J. MIller on Feb 19, 2018. ST PHOTO: RAHIMAH RASHITH
American palliative care expert B.J. Miller said that Singapore's move to ensure palliative care for patients in nursing homes is not disrupted was a good decision. PHOTO: THE BUSINESS TIMES

SINGAPORE - The Republic's proposal to ensure palliative care for patients in nursing homes are not disrupted is in the right direction and a financially sound move, according to a prominent American palliative care expert who was in town recently.

The proposal, if it gets adopted, means that patients do not have to turn to the most expensive options - acute care hospitals - in the event something happens to the original palliative care provider, said Dr B.J. Miller, a triple amputee and an assistant clinical professor of medicine at the University of California, San Francisco.

So, ensuring continued care is not disrupted "is the wise thing to do", said Dr Miller, who was in Singapore to present on palliative care at the Global Conference on Integrated Care earlier in February. The conference was organised by the Agency for Integrated Care (AIC).

Speaking to The Straits Times, Dr Miller was weighing in on the Ministry of Health's (MOH's) intention to appoint a temporary operator for residential care services, such as palliative care in nursing homes, as a stop-gap measure if operators cannot continue to function due to factors such as bankruptcy.

The temporary operator will ensure that all patients continue to be cared for until they can be transferred elsewhere.

The proposal for continued residential care services was one of several set out in the Healthcare Services Bill, which was unveiled in January. The draft bill is set to replace the current Private Hospitals and Medical Clinics Act, which was enacted in 1980 and last amended substantially in 1999.

The proposed bill will provide regulatory clarity for better continuity of care to patients and addresses wider issues of patient welfare.

  • Who is Dr B.J. Miller?

  • Dr B.J. Miller is a hospice and palliative medicine physician who sees patients and families at the University of California, San Francisco's Helen Diller Family Comprehensive Cancer Center, where he also teaches.

    Dr Miller's passion for palliative care stemmed from his personal experience. A accident he had when he was a Princeton undergraduate cost him three limbs - his legs and left arm - and nearly killed him.

    According to The New York Times, Dr Miller was a sophomore at Princeton when, after a night out, he and his friends decided to climb a parked commuter train. When Dr Miller got to the top, eleven thousand volts of electric current surged through the watch he was wearing into his body. His three limbs had to be amputated after that.

    The accident eventually led him to a career in medicine, and, ultimately, specialising in palliative medicine. His 2015 TED Talk - "What really matters at the end of life" - has been viewed over six million times on the TED website.

Dr Miller said that the proposal to step in and catch those who fall through the cracks due to a disruption in care services is a "financially smart move".

While the hospital is the most expensive place to receive care, it is also the backbone of care. "So, if you are going to fall through the cracks because of a lack of care services or because there are not enough facilities where you can live safely, you are going to find your way back to the hospital," added Dr Miller, who is the former executive director of a residential facility for dying patients called Zen Hospice Project.

He also acknowledged the need to extend the skill sets of palliative management beyond palliative specialists and also to the wider community.

"We need to drive the basics of palliative management across disciplines," said Dr Miller. "These are good skill sets for any good specialist and physician."

Similarly, Minister for Health Mr Gan Kim Yong earlier said in a speech at the Global Conference on Integrated Care that Singapore has already been deepening its manpower capabilities to support care integration.

General practitioners (GPs), who are closest to the community and easily accessible, can help provide palliative care during a patient's end-of-life journey through the Community Care manpower Development Award, which provides training support to GPs who want to provide care services for senior citizens.

"We are helping more GPs keen to collaborate with the community care sector to up-skill in the areas of family medicine, geriatric medicine, mental health and palliative medicine," he said.

AIC has given out 25 such awards to date.

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