A cool thing about LKCMedicine (NTU Medicine) is that we get early patient contact and exposure to the “real-world” healthcare setting from Year 1. Despite the myriad restrictions due to Covid-19, we were fortunate to still be able to embark on a week-long exploration of the polyclinic and its role in our nation’s healthcare scene.
I must say, I was a little crestfallen when I examined the schedule more closely and realised that our actual time in the polyclinic added up to only several hours over the entire week. This was their first time trialling “blended learning”. While I understood the need to minimise infection risk, I wasn’t exactly thrilled at the prospect of spending long hours on Zoom.
Despite my initial misgivings, the week turned out to be unexpectedly fulfilling.
Monday: Briefings and Lectures over Zoom
This was as imagined. A not-very-eventful day spent staring at the computer screen through various talks. The content was interesting and relevant, of course. For instance, we had talks on the evolution and current role of polyclinics in primary care.
However, the Zoom screen is a sad thing in itself. I was glad that my team decided to meet up in person, so that at least I was in the company of some “classmates”—rather than holed up in my dorm room alone. Half of my effort was expended trying to pay attention to whatever was being presented on Zoom.
Tuesday: Day One at the Polyclinic
Finally. It was with anticipation that we stepped into our assigned polyclinic early on Tuesday morning. After a perfunctory briefing by our mentor, we were split into pairs to rotate around the different clinic service stations. While we hurried from one half-hour slot to the next, every interaction and opportunity to observe was an insightful experience:
- Diabetic retinal screening: The first part was somewhat similar to a usual vision test (reading out increasingly smaller numbers from a distance), after which photographs were taken of the patient’s eyes (the machine used looked like a DSLR attached to a typical vision machine seen in spectacle shops).
- Doctor: We only sat through one very short consultation (for a diabetic case), although the doctor took the time after to talk to us about what it’s like to practise medicine in a polyclinic, and patiently answered my barrage of questions.
- Care coordinator: She seemed to do everything that integrated the patient’s care, from scheduling appointments, to checking medications and recommending future tests (e.g. mammography) and vaccinations (e.g. seasonal influenza vaccine).
- Care manager: We observed the consultation for another diabetic patient, though everything was run through in much great detail, including reassurances on the side effects of medications (e.g. metformin), checking the patient’s insulin injection technique, and counselling on diet and blood glucose control.
- Patient interviews: We then conducted interviews with two different patients, finding out more about their reasons for visiting the polyclinic and their medical history. Both of us agreed to disregard the interview guides, eschewed any form of note-taking, and simply focused on having a genuine conversation with the patient. Personally, I was surprised and gratified at how willing the patients were to talk to us, and how they seemed not to mind that we were taking up their time (perhaps their time in the waiting room was bound to be long anyway).
- Lunch: We were fortunate to have lunch with our assigned mentor (a polyclinic doctor himself), during which time I badgered him with questions—not regarding the job, but more on the polyclinic and healthcare system.
Wednesday: Another Day of Teachings over Zoom
Again, not much to be said. The first part was on healthcare financing in Singapore. Despite having read up on this even before entering medical school (for the interviews), I still found myself with no clear picture of the exactly what is what.
If even I was confounded by the different schemes and what each one was for, imagine how mind-boggling it would be for a senior citizen—or any other patient, for that matter. I wondered if there was someone or an AI service that would just tell each individual patient exactly which schemes, subsidies or grants they were eligible for, what were the benefits, and what they’d have to do to secure that. We’d heard about the financial counsellor as one profession in the polyclinic, but I found myself wondering: Are patients referred to the financial counsellor only if they voiced out that they are facing financial difficulties? And is this service provided free of charge?
Subsequently, we learnt about the roles of different healthcare professionals in the polyclinic. After a while I was no longer giving the speaker my undivided attention. Why not just let us experience and see all of this for ourselves?
Thursday: Day Two at the Polyclinic
This was another half-day of rotating between stations we hadn’t seen the previous time.
- Physiotherapist: The consultation was very interesting to observe, and the most thorough (and time-consuming) that we’ve seen by far; the physiotherapist’s patience astounded me as she meticulously went over the patient’s history and guided the older lady, in Mandarin, through each exercise.
- Diabetic foot screening: We probably spent less than 10 minutes here, observing the nurses check for nerve sensitivity (by poking at the patients’ feet with a filament), calluses and dryness of skin; a middle-aged man translating on the spot to Cantonese for his elderly mother reminded me of how important it is to pick up the common dialects in Singapore.
- Immunisation: We watched the nurse give standard childhood vaccinations to babies who were clueless about the whole procedure—until the needle was jabbed into their skin; the fresh wail was over as soon as it came, once the parents diverted the baby’s attention (“wave goodbye to jie jie!”).
- Dietitian: While there was no patient scheduled for consultation, she detailed to us the role of the dietitian, as well as the differences between the hospital and the polyclinic; it was insightful to see the presence of a multidisciplinary “teamlet” in the polyclinic, even when most specialist services were still based in the hospital.
- Developmental assessment: This is where they check a child’s growth, both physically and mentally (more adorable kids!); while we weren’t there for the whole consultation, we appreciated that signs of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) were detailed in the health booklet, for parents to seek medical advice early.
Friday: Presentations over Zoom
While everything was conducted over Zoom, we made the most of it. Our team had prepared a skit, and spent the past few days rehearsing movements and passing the iPad camera between scenes. We turned out to be the only one audacious enough to attempt a live skit (everyone else did PowerPoint presentations, or pre-recorded videos).
Each team was given a scenario of a common condition seen in the polyclinic (there was diabetes and hypertension, of course, and ours was on back pain). Essentially, we were to explore the condition as well as its ramifications and the patient’s perspective.
It turned out to be fun (I played the part of the patient’s mum who was vehemently against western medicine), and a good time for team bonding (we started playing Avalon and just chilled together after the presentation).
Some Final Thoughts
Overall, Polyclinic Week allowed me to see the patient’s perspective anew. We were just the same—common people, with common concerns. A mother asking for her tests to be scheduled on the same day as her consultation, to avoid always leaving her young child alone at home. A man worried about the several months it would take between getting a polyclinic referral and actually seeing a specialist at SGH. A young couple joking over the weight of their growing baby, which seemed to be above the curve on the growth chart.
The closeness of the polyclinic doctor to the community made the job seem all the more meaningful. I went in with questions—mainly revolving around the healthcare system and efficiency—and left with even more. I have penned down some of my personal thoughts and reflections (which I won’t bore you with here),
I just think it’s a privilege that we get this opportunity early on in our med school journey. Though brief, the experience enables us to understand the workings of the institutions that form our healthcare system, and to practise conversing with real patients. Looking forward to Hospital Week next.
Note: The names of the polyclinic and staff have been omitted. No patient details or identifiers have been disclosed out of respect for patient confidentiality.
This page is where I share everything related to life in medical school. The posts here may take on a slightly more casual tone and journal-like writing style. Ultimately, they’re just honest accounts of a medical student’s experiences – which will hopefully give you a glimpse of what med school is really like. 😊