Dr Tan Yia Swam, a General Surgeon (FRCS) who sub-specialises in breast conditions and also serves as the 1st Vice President of the Singapore Medical Association council, shares this real-life story from her more than 15 years of experience in patient care.
Jennifer is an average 45-year-old Singaporean mum, mother of 2 young kids, and looking after her elderly parents. She works part-time as a clerical staff, with a company health insurance. Her husband works full time in delivery service, with no health benefits.
While showering, she suddenly discovers a breast lump. Where can she go? Her first thought is to go to her company doctor, who then refers her to a panel breast specialist. This doctor happens to be male. Jennifer prefers a female doctor, and gets recommendations from friends for a female breast doctor, but this other doctor is not covered by her insurance.
So, she decides to go to a polyclinic to get a referral to a restructured hospital, but the waiting time to see a doctor is a few weeks away. Her childcare centre needs to compulsory shut-down due to an outbreak of hand-foot-mouth disease, and her 78-year-old father was admitted after a fall. Jennifer got very busy having to juggle all her commitments.
Since the lump is not causing any pain, she misses her own appointment. 1 year later, the lump has doubled in size, and when she finally sees a doctor for a workup, this is diagnosed to be a stage 3 breast cancer.
What could have helped her better?
Three things.
1. Awareness of the importance of regular health screening
2. Understand her medical insurance coverage
3. Understanding the healthcare infrastructure better
1. Awareness of the importance of regular health screening
Health screening means having routine health checks before any symptoms arise. While it may seem like a waste of money (health screening may range from $200 to $2000), I see this as a basic health investment. Yearly, or 2-yearly health screening to ensure one is in good health, as well as early detection of potentially major illness.
Talk to your trusted family physician to understand what is a suitable screening package for you- even something basic like body weight, blood pressure, sugar/cholesterol check can help to detect early hypertension, diabetes and hyperlipidemia. Lifestyle modifications (exercise, diet) may reverse some of these illnesses. Don’t wait for a stroke or heart attack to happen! Some forms of cancer may also be picked up at a pre-cancerous stage (cervical, breast, colon cancers).
Prevention is better than cure.
Early detection saves lives.
2. Understand medical insurance coverage
Having worked in both restructured and private hospitals, and more importantly, having been a patient myself under both systems, I cannot emphasize enough that one must have adequate financial coverage.
I only looked into this when I started my own family, and having more dependents. I’m no expert, but the basic concept is: you need to plan for periods in your life when you have a major illness and cannot work. How do I pay the medical bills? More worryingly, how do I maintain basic needs of living (rental/mortgage, school fees, groceries, utilities?)
Even if you have a decent company insurance plan, consider having your personal insurance- that can make up for areas which the company plan does not cover. Or what if you change employment at an older age, and you find it hard to apply for a new health insurance?
There are many plans available, by so many different companies. The common ones are “hospitalisation plans”, “critical illness plans”, death/disability plans”. I’m a layman in this field, and I believe in getting professional input. This is when professional financial advisors come in. No harm to talk to a few for second opinions, before deciding on what policies to buy.
3. Understanding the healthcare infrastructure better
I daresay Singapore healthcare is amongst the “best” compared to most countries. By best, I refer to the overall quality of care, reliability of lab tests, imaging reporting, and even authenticity of medications. This is largely due to strict legislation and governance by national agencies, and professional bodies. Each of us should understand the infrastructure better, so that we can utilise the best healthcare model for our needs, and our budget.
Polyclinics, General Practitioner (GP) clinics, GP chains, company GPs; restructure hospitals, private hospitals, being a private patient in restructure hospital, having CHAS card, Merdeka Generation, etc.
Having a good family doctor is the first step in anchoring your (and your family’s) health needs.
As an overview, Singaporeans may get good quality subsidised healthcare in a restructured hospital, and be admitted to C-class wards for major illnesses. However, there are downsides to this in terms of lack of privacy and lack of comfort. One must also accept the nature of shared care in a restructured hospital due to the nature of a large team (doctors, nurses, allied health, trainees, medical and nursing students).
To afford private healthcare, one needs to have good healthcare insurance coverage. Plan your budget and pay for one that suits your needs. Good financial planning, go hand-in-hand with good health, and investing time and money will protect both.
Dr Tan Yia Swam is a General Surgeon (FRCS) who sub-specialises in breast conditions. She is the Director of "Breast Friend Surgery & Wellness", and is the Clinical Director of Thomson Breast Centre, as well as a visiting Consultant to Nexus Surgical Associates at Mt Elizabeth Novena Specialist Centre.
She serves the medical community, as the 1VP of the Singapore Medical Association council, and the Editor of the SMA News.
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