Dr. Federick Samuel

Distinguished Guests, Ladies, My Colleagues and Friends,

On behalf of the College of General Practitioners Singapore, it is my pleasure and privilege to extend a warm-hearted welcome to all of you who have come here this evening.

Our College is ten years old and over the years, during the past decade, those of us who have been involved with the College have shared the same visions, aims and educational philosophies. We in the College in Singapore and those in similar colleges of general practitioners/family physicians throughout the world, are now absolutely certain that a college such as ours plays a vital role in the upkeeping and continual revitalising of general practice/family medicine, serving as the instigator and the co-ordinator of new and improved training programmes, the setting and assessing of improved standards and the promotion of general practice/family medicine as a new and vital discipline — thereby giving an academic standing to general practice/family medicine that it once lacked and improving the status and well-being of the family physician.

Since its foundation the College has come a long way, but it has not been an easy road. Progress which has been made has been the direct result of a tremendous amount of hard work and time given by those who are dedicated to general practice and the ideals for which the College stands. We can today reflect on some of the significant milestones that we have achieved in the educational and assessment fields — our continuing education programme for the practising doctor have encouraged greater participation by our members, our problem-orientated diplomate examination in family medicine has been recognised as an additional registrable qualification by the Singapore Medical Council, and our selfassessment home-study and audio-visual programmes are but some of the outstanding areas of progress. But the past has not all been success. It has not been easy for the College to obtain recognition as a significant academic medical organisation and our motives have been frequently misunderstood or misrepresented. But what has been done was part of the maturing process and in a sense, a preparation for the years that lie ahead. The College can therefore look back on the past with some pride in its achievements.

What of the future? As we enter a new decade the College must be seen as a dynamic body exercising professional leadership and pursuing vigourously its education objectives. Our explicit commitment is to raise and maintain standards of general practice, with particular regard for the undergraduate curriculum, immediate postgraduate training for general practice/family medicine and appropriate provision for ongoing continued medical education. The College believes that those entering primary care services either in private practice or the government outpatients services should be competent and cost effective, and the College has come up with data to prove that the trained family physician uses costly resources less than his untrained counterpart —by making fewer referrals to specialists and hospitals, and by the reduced use of expensive investigations and drugs.

The total cost of our health services is escalating by leaps and bounds. Our Minister of Health at a recent press conference stated that the government expects the cost of medical services to rise to $826 million in 1990 from $217 million last year. On the other hand, the corresponding revenue will go up by only $ 80 million —from $ 50 million last year to $130 million in 1990. These projections are causing great concern to our health planners as the burden is more than the government or our community could bear. There is therefore a compelling need for innovative cost effective approaches and methods to cope with the vast extent of current health needs aggravated by escalating costs, especially of treatment orientated hospital care. The government therefore now encourages the private sector to take over treatment of patients to a greater extent, especially at the ambulatory level, and envisages a "user pays" system, with public subsidy for health care reserved only for the deserving few. This would result in an increased flow of patients to doctors in the private sector, both generalists and specialists, and reduce the load on the government health services.

This means that the role and scope of general practice should be redefined and primary medical care should be reorganised to facilitate the delivery of comprehensive health care. It is imperative that there should be special training for the graduate entering primary care services, be it in the public or private sector; as well as the development of a proper career structure for the general practitioner of the future.

The time has therefore come for our medical school to meet the needs of the community and recognise the importance of enhanced primary medical care. Being the most cost-effective, the medical curriculae and teaching programmes should be redirected to enable the student to learn about the enhanced primary care doctor's special attitudes and skills and be taught in the content of the family physician as he applies his discipline in patient care.

Any such curriculum must teach a set of skills — intellectual and practical—that are specific to the clinical function of the generalist and family physician. Defining these skills more precisely, illustrating their uses and demonstrating them clinically in the domain of the family are the special educational assignments of a Department of Family Medicine.

The ideal undergraduate curriculum in family medicine offers didactic and experimental teaching throughout all the years of Medical School as an integral part of the medical students' experience. Such a curriculum requires co-ordinated planning and implementation in order to build in progressive levels of responsibility for patient care by medical students and to prepare interested graduates for more definitive training in Family Medicine at the immediate postgraduate level.

There is also a need for special training of the graduate entering primary health care services. Many graduates still move straight from their hospital training to solo general practice without adequate training for general practitioners who come straight from hospital employment, without an adequate period of supervised general practice, is likely to be inferior.

In the long term the community would benefit from a better quality as well as cost-effective service, if supervised training were available for all entrants to general practice. The College is willing, but is unable to undertake this vocational training without public funding. The lack of government support for general practice training in our Republic when compared with other developed countries, demonstrates that this lesson is yet to be learned.

Ladies and gentlemen, tonight we are admitting four members of our College to the Diplomate membership. I extend to them my warmest congratulations and look forward to their greater involvement in the College educational programmes.

The Albert Lim Award, designed to honour the memory of the late Dr Albert Lim, a very distinguished family physician, goes to Dr Feng Pao Hsii. He is being awarded for. his untiring efforts and contribution to the clinical training programmes for candidates in our Diplomate Examination over the years. Certificates of appreciation go to Drs Arthur Lim Siew Ming and Loong Si Chin for their outstanding services to the College.

The highlights of this evening's proceeding is the Fourth Sreenivasan Oration. This Oration is presented on an annual basis and is designed to honour both our Founder President, the late Dr B R Sreenivasan and the recipient invited to deliver the Oration. I am glad to announce that the proud recipient of the Fourth Sreenivasan Oration is Dr Frederick Samuel—a Fellow of our College —and currently the Vice President and the Chairman of the Continuing Education Unit of the College of General Practitioners Singapore.

May I conclude by thanking all our distinguished guests, friends and members for being with us this evening. By your coming and by your presence here this evening, you have given us a great deal of encouragement to face the challenges that lie ahead. To our donors, teachers, examiners and the many, many others who have helped us during the past decade, on behalf of the College of General Practitioners Singapore, I thank you most sincerely.

Finally, I would like to thank Dr Tan Tian Cho and his Committee for the splendid organisation of tonight's function.

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