December 2019 | Issue 45
Up-close with Associate Professor Tang Wern Ee

The recently appointed Assistant Dean for Family Medicine talks about her medical journey to LKCMedicine, her passion for family medicine and what the future for the discipline looks like.

Anne.jpgInterview by Anne Loh, Assistant Director, Communications and Outreach

Did you always want to be a doctor?

No. After "O" levels, one of my aspirations was to read English Literature at Oxford University. I did Arts course as a Humanities Scholar in my first three months of junior college. Much as I loved the Humanities subjects, after three months discovering the foundations of English literature – Beowulf, Canterbury Tales, the Arthurian legend etc, I came to the realisation that I was more left-brained than right-brained and switched back to the triple-science track. After "A" levels, I decided on medicine as a vocation as I wanted a career that would be of service to others.

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Was medicine a straightforward path for you?

I was blessed that I was accepted into the Faculty of Medicine at the National University of Singapore and managed to pass all my examinations with lots of prayer and support from friends, seniors and family!

When did you decide to pick family medicine?

I decided to be a family physician during my housemanship year. What I love about family medicine is that it focuses on the person as a whole – the physical, psychological and social aspects all come into play – and family physicians manage patients of all age groups, from infants to the elderly in the community.

Tell us about your medical journey to LKCMedicine.

I started my family medicine training as a second-year medical officer with the Ministry of Health. Since passing my Masters in Family Medicine, I have been a family physician with the National Healthcare Group Polyclinics (NHGP). NHGP encourages and provides opportunities for Family Physicians to be involved in medical education and I started teaching medical students at the polyclinics as a junior family physician. I had a very small role in some of the initial planning of the LKCMedicine Family Medicine curriculum in the 'start-up' phase of the School. In 2013, I was appointed to the faculty of LKCMedicine. Since 2014, I have been Lead of Clinical Methods. In 2016, I was appointed Lead, Student Assistantship Programme, Family Medicine and in August 2019, I was appointed Assistant Dean, Family Medicine.   

Why do you think family medicine is not regarded on par with other specialisations?

There are a variety of reasons why family medicine is not regarded on par. One of the reasons could be that the generalist clinical skills of a family physician are less highly valued than the specialised skills of a specialist.  However, a generalist skillset does not equate with poorer clinical skills or poorer clinical acumen. Indeed, the generalist skillset and care provided by family physicians is the cornerstone of many healthcare systems and provides comprehensive patient care at lower cost.

What is the ideal for family medicine?

The ideal family medicine practice provides person-centred care for families within the community, sees to their physical, psychological and social needs / concerns and provides coordination of comprehensive healthcare services including specialist care, where necessary.

Instead of being just the anchor physician for your everyday medical and healthcare issues, the call is now for those in family medicine to be the first line of defence or the gatekeeper in spotting more serious issues. What are your thoughts on that?

Family physicians who work in primary care are often the first point of contact with the health system for many patients. As such, family physicians are called upon to distinguish serious medical issues that require further investigation or management at a specialist / tertiary healthcare setting from other conditions that may be managed in primary care. This does not detract from the role of family physicians as the anchor physician for the daily medical / healthcare issues of the patient.

What qualities should a medical student / trainee doctor have for family medicine to be a perfect fit?

Some of the qualities that would fit a vocation in family medicine would be good interpersonal and communication skills, compassion, integrity, ability to handle uncertainty and ambiguity, enthusiasm to learn, and the willingness to work hard.

With the rise of technology (and perhaps telemedicine), what do family medicine practitioners have to do to face the future?

The practice of family medicine, as with the practice of other professionals, has to evolve in tandem with the needs and / or demands of the community in which it is embedded. Family medicine practitioners will have to incorporate and / or find ways to work with technological advances that are relevant to their practice. A mindset that embraces change and makes considered judgements on the applications of innovations that arise will enable family medicine practitioners to remain relevant through the ages.   

With your appointment as Assistant Dean for Family Medicine, what changes will you be making?

I aim to increase the profile of family physicians and family medicine as a discipline at LKCMedicine, so that students will not only gain knowledge and skills from their family physician faculty but also a better appreciation of the discipline and the practice of family medicine in Singapore. The ultimate aim being not simply to improve the talent pipeline for family physicians in Singapore but also that future colleagues in other disciplines and specialities will have a good understanding and respect for family medicine and family physicians. I plan to work with family medicine departments in other universities and healthcare institutions, both locally and internationally, in the areas of medical education and research.

Which part of the LKCMedicine MBBS curriculum are you involved in?

Currently, my involvement in the LKCMedicine MBBS curriculum spans from Year 1 to Year 5.

In year 1, I organise the Polyclinic Week postings at NHGP. As Clinical Methods Lead, I am involved in the development of teaching materials, faculty development, volunteer patient recruitment and conduct of the Clinical Methods teaching module at LKCMedicine and as Lead of the Year 2 Objective Structured Clinical Examination (OSCE), I am responsible for the conduct of the Year 2 OSCEs. In Year 4 and 5, I work closely with my family physician colleagues to plan the learning activities and placements for the Year 4 family medicine posting and the Year 5 Student Assistantship Programme family medicine postings.

How has the teaching of family medicine today changed from when you were a student?

Compared to my undergraduate student days, there is a much larger emphasis on family medicine and the role of family physicians in the medical education and healthcare delivery system. Family physicians are medical educators in more areas of the curriculum (eg as facilitators in the teaching of Year 1 & 2 Foundations of Clinical Practice - Clinical Communications, Clinical Methods and Practical Skills) and there is more curriculum time allocated to family medicine and teaching of medicine in the community.

You are also head of the clinical research unit (CRU) at NHGP. What are your areas of research interest?

My area of research interest is in health literacy and chronic disease management. I am one of the Team Leads for 'Primary Health Care Research In Multimorbidity and Mental Health in a Multi-Ethnic Population (PRIME)', a National Medical Research Council (NMRC) Centre Grant in which NHGP is partnering the Institute of Mental Health and LKCMedicine to build up research capabilities in primary care in Singapore in the areas of multimorbidity, understanding and improving treatment-related behaviours of patients and the physical health needs of patients with mental health issues. I am currently conducting a study into predictors of medication adherence in patients with asthma.

I am also involved in health service evaluation of new programmes at NHGP, to evaluate the impact of healthcare service delivery so that we continually improve the care we provide to patients.

What else do you do as head of the CRU?

As Head of the NHGP CRU, my responsibilities include providing leadership to advance research initiatives in NHGP, oversee research activities in NHGP, create career paths and opportunities for clinical research support staff, analysts and researchers at NHGP. I also provide stewardship of the use of research funds within NHGP, including funds from the $5-million PRIME NMRC Centre Grant.

Do you still practise family medicine?

Yes, my clinical practice is at Ang Mo Kio Polyclinic.

What other hats are you wearing?

I am a member of the Faculty, Fellowship Training Programme of the College of Family Physicians, Singapore where I teach Evidence-Based Practice. I am also a Senior Consultant at the Policy Evaluation and Research Division, Ministry of Health.

What hobby do you have which helps in your work?

I like to travel, I think it helps in my work by giving me an opportunity to recharge and take my mind off work!

What do you do to relax completely?

Tending to my orchids or going to a plant nursery to shop for more orchids!