Dr Rodis is a qualified Geriatric Physician from Vancouver, Canada who was attached to Khoo Teck Puat Hospital for a 1-month fellowship on Perioperative Care of the Elderly, from 12 March to 8 April 2018.
As a Canadian geriatrician interested in perioperative care of the elderly, I recently had the wonderful opportunity to spend a month working with the Geriatric Surgery Service (GSS) in Khoo Teck Puat Hospital (KTPH). During that time, I had the pleasure of working with the transdisciplinary geriatric surgery team, the general surgeons, the geriatricians, the integrated hip fracture unit, the dementia programme and the community outreach programmes.
Most of my time was spent with the geriatric surgery service, a vibrant group that has been built up over years by passionate and driven people with a shared vision. Coordinated by the surgeons, it truly is a transdisciplinary model of care, where multiple health specialties and disciplines work together to achieve patient goals.
They call it the Start to Finish (STF) programme for a reason. I followed patients through the process from their perspective, and could see that they were at the centre of care throughout. The first key step was the surgeons making sure they truly understood the patients' goals and values. Then, based on that, the geriatric surgery service could be activated by the surgeons to help guide decisions about feasibility of these goals in the setting of their overall health status as well as to work on optimizing recovery. Postoperatively, they were seen again by the dietician and physiotherapist to enhance recovery.
This concept of ownership is one that is truly well considered within the team, and, in fact, throughout the numerous services I worked with at KTPH. Within the geriatric surgery service, I saw that each specialist is responsible for and accountable for their share of the patient's care while still knowing what the other team members do. This allows them to see patients quickly and communicate effectively with each other. They truly are a team; I had the opportunity to meet each of them and the comraderie is palpable.
One of the most unique experiences I had there was seeing the prehabilitation programme in place for frail patients. The physiotherapists work one on one with the patients and come up with an individualized exercise program that is supervised and focuses on goal-directed, functional movements. Their important patient-related outcomes – such as functional recovery to baseline – have shown quite impressive results since the onset of the STF programme.
I went to Singapore figuring that I'd get to see what it was like. I left inspired, with a new dream to start a similar program in Vancouver. Coincidentally, my colleague in Vancouver who connected me with the team in the first place ended up being there at the same time. We bonded over the shared experience of eating far too much laksa at family dinners with our gracious and kind host while planning how to bring the dream back to Vancouver.
From exploring the great sights of Singapore in the deadly heat (which I am told I complained about on an unusually cool day) to becoming a part of the team, this was an experience that I'll never forget and I'll always be grateful for.
One of the key lessons I took home from this experience is how to establish sustainability. A transdisciplinary care model where each discipline has a champion who takes ownership over their role is important. I only hope to have the fortune of working with people who are such dedicated champions back home.