18-year-old Dr Darren would joke that volunteering as a librarian at Gleneagles Hospital is the closest he would get to pursuing Medicine. He had applied to the National University of Singapore (NUS) School of Medicine but was not successful. Instead, he was offered a course in Life Sciences which he had accepted, seeing it as an opportunity to contribute to the healthcare space through academia. Like all Singaporean men, he then postponed his studies, enlisted in the Singapore Armed Forces and spent the next 2 years in National Service.
These 2 years provided time for internal reflection, during which Dr Darren realized that pursuing medicine was what he was truly passionate about. An opportunity arose, and he applied to and was accepted into Medicine at the University of Melbourne. He packed his bags and left for Melbourne in February 2004. He thoroughly enjoyed his stint as a student abroad, however home was always on his mind and he knew that he would always want to return home to practice after graduation to better the lives of his fellow countrymen. He realised that while the experience abroad was exciting, the patients and practice of medicine differs greatly between countries and studying locally would put him in a better position to serve his future patients well. That same year after his first semester abroad, he re-applied to NUS and this time was successful.
After graduation, Dr Darren rotated through acute hospitals, as a junior doctor and subsequently took up training as a Family Medicine Resident. During one such rotation at an acute hospital, he encountered an elderly patient who was admitted multiple times within a short three month window. She would be treated, discharged but would return soon after with the same condition. She lived alone and was unable to care for herself adequately in the community at home. While on-call one day, Dr Darren was called to attend to an unwell patient; it was this same elderly patient but this would be the last time he was to care for her - she subsequently passed away that night in the hospital and Dr Darren had to certify her death. This sad experience, was however, the spark for him to look at eldercare beyond just medical treatment - It spurred him to think about what can be done for vulnerable seniors living alone in the community, and what more can be done for persons like her to live life to the fullest at home and minimise hospitalisations.
As part of his residency in Family Medicine, Dr Darren moved to practising family medicine at a polyclinic, where he saw up to 70 to 80 patients per day, many of them elderly with multiple and complex medical problems. The polyclinic experience allowed him to treat a broad range of conditions and develop a large base of patients, but it left him wanting to do more. Given the time constraints of each consult, he was not able to understand the social circumstances that his patients came from, how they lived, what they valued and what were their barriers to seeking and complying with medical care He realised that to truly make a difference in chronic disease management, he needed to embed his practice in the community and develop long term therapeutic relationships with his patients in order to first understand them as persons, beyond their medical conditions, and then as patients.
He found such an opportunity in 2016 when he was offered a position at NTUC Health to practice Family Medicine in multidisciplinary settings across different community based care units - The Family Medicine Clinic, Home Medical as well as in Nursing Homes. Being entrenched in a community and assigned patients to look after meant that he was now able to develop the long term physician-patient therapeutic relationships that to this day remains the primary motivation behind his passion for care of the elderly.
Dr Darren and his colleagues in Family Medicine Clinic
Today, Dr Darren also holds a Masters in Public Health, supported by a scholarship from the Agency of Integrated Care (AIC). He was awarded the Community Care Manpower Development Awards (CCMDA). He is also an Assistant Director of Clinical Services at NTUC Health, and recently worked on a study at three NTUC Health Nursing Homes, (Chai Chee, Jurong West and Geylang East), to further Palliative Care research.
Dr Darren's study found that access to palliative services increases the chances of residents passing on in comfort at the Nursing Home rather than the hospital by almost 5 times as compared to having completed an Advanced Care Plan (ACP) which only increased the odds by 2 times, which was not statistically significant. Such palliative care services involve:
- End-of-Life Clinical Care - prescribing medicines at the Nursing Home targeted at providing comfort and alleviating symptoms of pain and discomfort.
- Pastoral support - involving family members in decisions on how to manage care, including whether to transfer seniors to the hospital for acute treatment, or allowing them to remain at the Nursing Home where family members can spend their last moments with seniors.
His study suggests that an ACP alone without access to palliative services is insufficient to enable more seniors to pass away in comfort and dignity in the community. These findings were presented at the Singapore Health and Biomedical Congress 2023 and he will be participating in more research around palliative care in nursing homes.
Dr Darren at the Singapore Health and Biomedical Congress 2023
The results of such a study are especially useful against the backdrop of limited beds in acute settings.
Dr Darren's journey exemplifies the work our physicians do in maintaining the quality of life for our seniors and the humility to further our understanding of eldercare with a heart for patients. He passes on this passion to new doctors he recruits to NTUC Health's Family Medicine Clinic.
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