I refer to the Opinion piece by Dr Tan Kok Yang on the difficulties of taking care of senior patients (As seniors become caregivers to seniors, can doctors lighten their load?, Sept 5).
Indeed, there are several challenges faced by elderly patients who consult specialists at hospitals.
Many elderly patients have mobility issues. It is often difficult for them to visit a clinic via public transport independently.
Family members may have to book costly transport like a wheelchair-compatible van to ferry them to and from the hospital. At least one family member needs to take leave from work to accompany the elderly patient. Many elderly patients have several medical problems and often need to consult several specialists.
My patient, 80, fell and fractured her leg. She was also found to have poorly controlled hypertension, chronic renal impairment and severe hearing impairment due to old age.
She underwent surgery for the fracture. Upon discharge, she was given specialist outpatient appointments to see an orthopaedic surgeon, an endocrinologist, an ear, nose and throat (ENT) specialist, an audiologist and a dietitian.
But all five specialist appointments were on different dates, meaning her children needed to take five days of leave and pay for five transport trips.
After much pleading from the family, the hospital managed to schedule the appointments to see the orthopaedic surgeon and the endocrinologist on the same day.
Due to the difficulties in organising different trips to the hospital, the family decided not to see the ENT specialist, the audiologist and the dietitian. This will lead to suboptimal care.
To overcome the challenges, I suggest that hospitals schedule patients’ many specialist appointments on the same day. This is feasible as most specialists run clinics every day at hospitals.
Hospitals could also use technology to minimise unnecessary in-person clinic visits. Consultations like those by dietitians can be made via WhatsApp video.
Specialists could also run specialist clinics at polyclinics, which are probably nearer to the patients’ homes.
It is easier to send one specialist from a hospital to a polyclinic, than for many elderly patients to go to the hospital.
General practitioners and family physicians could be trained to take care of more medical problems. They could, for instance, then handle my patient’s post-operative care and blood pressure control, give dietary advice and arrange for hearing aids for her.
More effort can be made to better take care of our ageing population.
Desmond Wai (Dr)
