The Outcome-centric Conversations We Should Be Having with Our Doctors

Hello, my name is Marcus Seah. I am a 2nd year medical student from Ponya. This is my medical column and the aim is to talk about medical issues, specifically those of public health. Public health issues concern the overall health of people rather than specific diseases and treatments. Dental care is one example. Many of these issues are worth giving a thought about, but are seldom discussed.

This series, in particular, aims to touch on life nearing death. This series is done with information obtained from interviewing Dr Alethea Yee Chung Pheng, senior consultant at the National Cancer Centre Singapore.

Dr Alethea Yee is the Head and Senior Consultant at the Division of Palliative Medicine, National Cancer Center Singapore. She graduated from Yong Loo Lin School of Medicine, NUS in 1993 and proceeded to the UK for postgraduate training in Internal Medicine with subspecialty training in Palliative Medicine. In 2006, she joined National Cancer Centre Singapore to run the palliative care service there.

Dr Yee is also actively involved in education. She is the Director of Education for Lien Centre for Palliative Care, Director of Nursing and Allied Health Education, Academic Clinical Programme and Program Co-director of Ngee Ann specialist diploma in Palliative Care Nursing. In addition, she sits on various centre-wide, cluster-wide, and national committees for medical training and service development.

Her research interests are in quality of life in advanced illness, care models and pathways, and education research in palliative care training.

This essay is part 2/3 of this series.

A lot of times, doctors give patients or their family members options of medical treatment to choose from. Which is problematic because many of these people are not equipped with enough knowledge to assess each option carefully.

For example, your loved one slips into a coma, and the doctor asks if your loved one wishes to be resuscitated or not. Or perhaps by some ill luck, you’re struck with cancer and the doctor presents you with a new experimental therapy, there are risk and benefits. You are unsure. That is fine because you were not educated in this field.

Instead, doctors and patients should consider outcomes, which matters to them and how those options can or cannot help reach those desired outcomes. These options are tools, not outcomes.

Patients may not have the knowledge to make decision on the tools but they are surely capable of making decisions on the outcomes because they know themselves best.

When we have outcome-centric conversations, patients and doctors can play their roles better. Patients know what their wishes are and doctors know how the tools work, thus allowing the doctors to fulfil the patient’s best interest. “It brings about a healthy partnership between doctors and patients by allowing each party to do what they are good at,” Dr Yee said.

It is precisely because outcome-centric conversations highlight the interests of patients that gave rise to an initiative by the Agency of Integrated Care of the Ministry of Health (MOH). This initiative is called advance care planning. Advance care planning is planning for future medical situations by identifying your wishes and stands on certain difficult and complex issues such as resuscitation.

This process is usually done with a trained facilitator or a healthcare professional. By having an advance care plan, it better identifies the patient’s wishes to be taken into account when an emergency or medical scenario arises. This is better than having not expressed any wishes and having the family members and doctors ballpark the patient’s wishes. By having the patient go through the advance care planning process, the patient is able to highlight his/her own wishes to be taken into consideration.

This process is documented via a form on the agency’s website. This form should be reviewed regularly to maintain the currency of the wishes. Patients diagnosed with terminal incurable diseases such as cancer or old, frail patients are encouraged to begin this process so that if by any chance, should anything happen, the attending doctors are aware of their wishes.

However, aside from that group, as a matter of fact, we should all be asking ourselves “What matters to us?” As a society, we should be having this conversation more with our families. Not only does it identify our wishes, it helps us puts things into perspective of what is important to us.


Feel free to drop by more information on advance care planning.

Feature image adapted from here.

About the Author

Marcus is a 2nd year Ponyan from Tembusu. In his free time, he studies medicine.