| TUESDAY, NOVEMBER 8, 2016 | THE STRAITS TIMES | OPINION A25 The doctor will see you now – in a new light

Patients and families can be ‘activated’ to become more proactive in taking charge of their care, working closely with healthcare professionals.

Effective engagement is not Mark Chan about achieving patient “compliance” with professional For The Straits Times recommendations, but about promoting dialogue and building trusting relationships between One in five complaints to the patients, families, healthcare Singapore Medical Council (SMC) professionals and the community. last year resulted from poor Each participant in the care communication between doctor continuum has a better and patient, it was reported in understanding of the relevant September in The Straits Times. concerns, and shares the To remedy this, the SMC has responsibility of determining published revised guidelines for decisions for treatment. ethical conduct and Cansuch “activation”ofpatients communication for the medical andfamiliesbepossible here?There Having “activated” patients and family members means encouraging positive healthcare behaviour, such as going for screenings. Studies show profession, to better align arebarriers. Ina fast-pacedsociety, that such patients are more capable of managing their conditions and have lower rates of hospitalisation and healthcare costs. ST FILE PHOTO professional behaviour and to weprioritise othereconomic moderate patient expectations. pursuits abovehealthcare for However, a set of well-crafted ourselvesandour families. guidelines alone is unlikely to Where clinicians are concerned, Dementia patient’s son steps up to be an ‘activated’ caregiver achieve these vital goals. many of us are not equipped How can patients and families with the necessary skills to Madam Kwok is an elderly wom- quired and anticipates the re- daycare facility, for example. feel empowered to take charge of engage and activate our patients an who was diagnosed with de- sources required. He started attending the many their own healthcare encounters and families. mentia 10 years ago. Initially a He will do online searches to caregiving talks offered by the and establish a balanced and Our healthcare funding structure cheerful, active woman with a better understand the indications Alzheimer’s Disease Association. trusting therapeutic relationship inadvertently places greater focus fondness for singing karaoke, she and side effects of medications There, he obtained more useful in- with their doctors? on crisis care over health grew increasingly quiet and even- his mother is taking, clarifying formation about dementia from Patients, families and societal maintenance, and dis-incentivises tually lost her ability to speak. with the doctor about the informa- facilitators, and enjoyed the shar- “activation” are the key. Activation individuals and families from Her ability to perform basic ac- tion learnt. ing of related experiences and refers essentially to having the staying healthy and self-managing tivities of daily living declined. As a result of his better under- peer support from other caregiv- knowledge, skills and confidence to their chronic illnesses. This started with assistance for standing of the medications, Mr ers. He brings home the lessons manage one’s health in such a way Evidence-based interventions bathing and toileting, progressing Kheng was confident in the daily on physiotherapy, feeding and as to improve one’s health-related such as coaching, self-management to dependence for even feeding preparation of his mother’s medi- methods to engage a person with outcomes. support and peer-to-peer support and dressing. The burden of look- cation. dementia, to help his mother. Having “activated” patients and are not readily available or given ing after Madam Kwok as her con- Madam Kwok’s symptoms Mr Kheng continues to cope family members means sufficient funding. dition declined fell mainly on her have been well controlled over well while caring for his mother, encouraging positive healthcare To be fair, progress has been son, Mr Kheng. the years. She was warded only often sharing with me new discov- behaviour, such as attending health made in recent years. The Agency Rather than feel helpless and four times (for unexpected infec- eries about her which he encoun- screenings and keeping up with a for Integrated Care has been highly overwhelmed, Mr Kheng decided tions) over the many years under ters daily. healthy diet. Studies show that effective in designing and to take charge of his mother’s my follow-up. By becoming activated, he trans- activated patients are also more coordinating elderly healthcare care. During consultations, he Talking to our nurses, Mr Kheng formed caregiving from a poten- capable of managing their medical resources based on ongoing asked me multiple questions on also found out what community tially stressful and demoralising conditions, and have lower rates of feedback from end-users. the nature of the illness, its im- resources are available for people experience, to one which is fulfill- hospitalisation and overall Rather than viewing the pact on patient and family, and with dementia and explored ing, with quality time spent with healthcare costs. They are also community as passive recipients of the complications to be expected. these options on his own. In a bid his beloved mother. positive role models for other care, the Ageing-in-Place In doing so, he is better pre- to keep his mother engaged, he en- patients. programme organised by the pared for the burden of care re- rolled his mother in a dementia Mark Chan Insteadofbeing passive recipients Alexandra Health System has ofcare,such patients feel nurses working closely with empoweredandactive, eventually grassroots leaders to meet both becomingvolunteers, partnersand healthcare and social needs of the be better informed about their successful projects such as a zone of passively receiving care and evenleadersin co-creating better frail elderly. medical conditions. collective effort to improve hand medications, to ask more questions healthcarewith their doctors. In the same vein, the Neighbours The roles of volunteers in hygiene in the hospital. and seek ways to improve their own What would such behaviour look for Active Living initiative by the healthcare in Singapore are ever In the face of multiple challenges health and the healthcare services like? The example of Mr Kheng Eastern Health Alliance entrusts expanding, from manning helplines posed by an ageing population, we they receive. (see sidebar) and his mother sheds volunteers living close by to take on to befriending the confused elderly all need to step up and be activated. some light. the task of monitoring the health in hospital overnight – filling vital As a doctor, I need to spend the [email protected] status of the elderly with multiple gaps of service in the complex necessary time to educate my DOCTORS MUST DO THEIR BIT chronic diseases. healthcare system. patients and families about their • The writer is the head of Doctors must also learn to be better Many in our society have also The Tan Tock Seng Hospital health conditions, and to provide department and senior consultant The Straits partnersTimes with, Pg patients A25, and8 Novemberrisen 2016 to the challenge to be CareConnect Volunteer opportunities and resources for geriatrician at Tan Tock Seng Source: Thediminish Straits their Times role as the© Singaporeactivated. Press Holdings Limited. Committee, comprising an equal them to take charge of their health. Hospital, and co-chairman of the paternalistic authority to become More are joining disease support number of volunteers and Patients and family members will TTSH CareConnect Volunteer Permissionmore required effective for coaches. reproduction groups to provide peer support and healthcare workers, has completed need to move out of the comfort Committee. Rumours of a literary uprising in Singapore are true

What’s so exciting for me as a writer for programmes as diverse as cannot be taught. Creative writing taught in Singapore from 1968 to haven’t surprised yourself, you Darryl Whetter and writing professor is to see how teaching secondary school students now thrives on the workshop 1971 (at what became the National haven’t written.” Moving here to be allthis activity is drivenby a to write andperform slam poetry model. Rather than lecturing at a University of Singapore) and the inaugural director of Singapore For The Straits Times combination of individual andrunning the annual writing student for three hours, we subsequently set his 1973 novel and South-east Asia’s first taught creativity, government arts support tutorial programme, Mentor Access demonstrate techniques and Saint Jack here. His much later creative writing master’s and private enterprise. Visit the Project. In just a few years, peer concerns but also invite students to memoir, Sir Vidia’s Shadow, is a programme has that kind of Having recently drawn 211 people passionate Mr Kenny Leck at his editing group, The Singapore constructively critique one diptych portrait of two writers: understandable-only-in-hindsight outto Lasalle College of the Arts for store, Books Actually, and the book Writers Group, went from forming another’s work. Several of my Theroux and his former mentor kind of surprise for me. I’m elated apackedeveningtalkonthepower seller/publisher can point to to self-publishing an anthology of students over the years have V.S. Naipaul. A young Theroux asks to be at an art school. Even in of metaphor in writing, I’m more several of his Math Paper Press itswriting to being published by uttered the same praise for Naipaul if he should bother to famous writing programmes in the confident than ever that the poetry titles that are in their third or Ethos Books and featured at the workshopping: “It’s easier to spot continue publishing book reviews US and Britain, student and faculty rumoursare true: The literary scene fourth printing of a thousand copies Ubud Writers Festival. mistakes in someone else’s work when it means his fellow writers writers are usually isolated from in Singapore is truly exploding. each. My native Canada manages to Artistsare always in dialogue with than it is in your own.” will sometimes hate him. “Yes,” other campus artists. At Lasalle, we Eversince Iarrivedin earlyAugust have the world’s richest poetry theirculture. Creativewriting, Also, crucially, students inspire Naipaul replies, “reviews force you pass one another every day. Every todirectSingapore’s firsttaught prize in English – the C$65,000 particularlyatthe postgraduate one another. There’s always a to make judgments.” A good storyteller can learn from an actor. creativewriting master’sdegree at (S$67,000) Griffin Poetry Prize – level,isoneof therare growthareas crystallising moment somewhere creative writing degree improves Visual artists have so much to offer Lasalle,everyoneI’vemet in thearts yet it’s hard to sell 1,000 copies of a inthe artsand humanities.In the US, on either side of Project Week the analytical sensibilities of our poets and screenwriters. hastold me that the nationalliterary book of poems there. thenumber ofpostgraduate writing when students start writing in ways writers through editing as well as Elsewhere, a school with a great scene,whileneveridle, has really Everyliteraturelover Iknowhas a programmesdoubled between1985 they never anticipated while their powers of observation, writing programme might have a takenoff in the pastfive toseven warmspot in hisheartfor San and2005.In Canada,there wasa simultaneously challenging one language skill and social-emotional much larger programme in years.WhenI’m not workingon my Francisco’sCity Lights Bookstore. newcreative writingmaster’s another to keep raising the bar. intelligence in their own fiction, business, dentistry or engineering nextnovelor planning thegraduate MywifeandIwere delighted tostop launchedevery other year Several of our graduates will work poetry, drama or non-fiction. overshadowing the artists and writingworkshopsfor our first thereon our movehere from throughoutthe2000s. Australia’s as editors in the publishing sector Singapore’s fecund literary performers. At Lasalle, everyone is Januarysemester, I’m outat literary Canada.City Lights isgreat, but a lot evenmoreactive. It has just about precisely because our programme scene, combined with the chance here for the arts. Everyone. events withSingapore’s writers, ofitsvalue isnow nostalgic. Books two-thirdsof Canada’spopulation forces them to articulate why one to teach postgraduate creative It’s surely a coincidence, but publishers,educatorsandarts ActuallyandMath Paper Pressare butnearly 10times asmanyPhD piece of writing is better than writing students at a renowned art tattoos in Singapore seem to also administrators.Everyoneagrees toSingaporenow what City Lights programmesin creative writing. another. There’s a great moment in school, was enough to tempt me to have taken off in popularity during thatthe literary scenehere appears wasto theexploding American Singaporeismore than readyfor a Captain Fantastic, a movie from come here from halfway around the this same time. The ink is certainly tohave reachedcritical mass. literaryscene 60years ago. master’sdegree in creative writing. this summer in which Viggo world. In my 16 years of university flowing well in Singapore. Evena newcomer like myself can TheSingapore Writers Festival There are several advantages to Mortensen plays a demanding, teaching at four different Canadian spot the uptake in literary has grown from a biennial event to doing a master’s degree in creative counter-cultural father. His universities, including as the [email protected] productivityand influence. The oneof the most popular literary writing, both for the individual homeschooling of his children creative writing coordinator at Epigram Books Fiction Prize has festivals in the world. There’s no writer and for his culture. First and includes a ban on the word Halifax’s esteemed Dalhousie • Dr Darryl Whetter is programme doubled its prize money to a total difference between itsauthor foremost, it accelerates a writer’s “interesting” when it comes to University, I’ve always quoted leader of the master’s in creative purse of $40,000, and the prize was line-up and those of festivals in New development. No one thinks you analysing books. Why, this different writers on the value of writing at Lasalle College of the Arts. created only last year. I recently York,London, Toronto or Sydney. can learn to weld, scuba-dive or character and creative writing surprise in writing. Robert Frost He will moderate a panel discussion attended the launch of SG Poems Singaporean poets like Chris make clothes without being taught. degrees want to know, is one book argues, “No surprise for the writer; on “Writing as a Moral Compass” 2015-2016, the National Poetry Mooney-Singh are able to secure I’m baffled that people still cling to better than another? no surprise for the reader.” Eudora at the Singapore Writers Festival Festival’s first anthology of poetry. the National Arts Council’ssupport this romantic notion that writing American writer Paul Theroux Welty is even more blunt: “If you this Saturday.