By Chang Ai-Lien, Science Correspondent
ON SATURDAY morning, oncologist John Wong saw what for him was a typical patient.
The 66-year-old woman had a history of three different cancers, on top of diabetes, high blood pressure and cholesterol, heart damage, asthma, osteoporosis and kidney problems.
Singapore's ageing population means that he is treating more patients like her.
The median age of Singapore's resident population shot up to 37 this year - compared to 20 in 1970. And by 2030 those aged above 65 will rise to 20 per cent of the population.
'When I was a young doctor in 1981, we still had a relatively young population and patients came with one problem. You fixed it and they were fine,' says Professor Wong, 52, who is dean of the National University of Singapore's Yong Loo Lin School of Medicine.
'Now we are treating far more elderly people. With people growing older, a large number are coming in with multiple problems and the cost of treatment has gone up substantially.'
Alongside this ageing of patients, there is an escalation in the sophistication of treatment and giant advances in medical science.
For example, 30 years ago, a heart attack victim was given oxygen, one or two drugs, and put to bed. Now, he says, there are at least six steps to rush through. If an angioplasty is needed to restore normal blood flow to a blocked blood vessel, it is done within 58 minutes from the time a patient lands in the National University Hospital (NUH) emergency room.
He says that the growing numbers of elderly people and the complexity of medical treatment these days mean that the training of doctors has never been more important.
'This is best in the world care, it puts the doctors under tremendous pressure, and we have to have the training for it.'
The revamp of postgraduate medical education unveiled last month by the Health Ministry is key to keeping training in line with the seismic changes that are taking place in medicine, he said.
The new regime will see the present 'more ad hoc' training of doctors replaced by a formal curriculum at a specific hospital, with interns taken under the wing of senior specialists. The time taken to produce a medical specialist will remain at five to seven years.
What trainee doctors have to master each year will be clearly spelt out and tested via a formal assessment. And individual hospitals are to be responsible for training rather than having trainees assessed by the various heads of department as they cover disciplines in rotation.
If a doctor wanted to do medical oncology, for example, the first three years would be devoted to a structured programme in general medicine, because cancer can affect multiple systems. Once this was mastered and assessed by examination, the resident would then move into three years of specialty training in medical oncology which would be similarly structured with graded responsibilities and complexity of cases and skills. At the end of this would be another exit assessment.
The best mentors need to be chosen as teachers under the new system, with dedicated time during working hours for teaching.
Currently, doctors teach on top of having to attend to their patients.
'When I taught, I had to do it before 8am or after 7pm,' says Prof Wong. 'And I can't tell you how many times I had to stop to see a patient. Something had to give.
'We need good doctors to be given the time to teach, and teach well. The last thing we want to think is 'those who can't do, teach'.'
He does not think that allowing graduating medical students the option of skipping 12 months of broad-based hospital training as housemen to head straight for specialty training, as compromising skills in any way.
The change - structured along the lines of residencies in the United States - has had some doctors here worried that interns might miss out on critical generalist experience.
Core skills picked up during the housemanship year, including practical work in internal medicine and general surgery, will be built into the new curriculum, emphasises Prof Wong.
'Housemanship is not being dropped, it's very much there under a different name. Existing structures aren't being demolished, that's a misconception. What we're doing is actually a major enhancement to the system.'
Alongside the changes to the postgraduate programme, the Yong Loo Lin School of Medicine is ramping up the number of medical students it takes on each year, from 260 currently to 300 students by 2012. This is to keep pace with the ageing population and the large number of senior doctors leaving for the private sector.
'The need for more and more highly trained doctors has never been greater...We're riding the health-care service so hard, down to the bone. Doctors are being stretched thin,' he says.
Known for his wonderful bedside manner, the doctor to many of Singapore's elite accepts that medical school is only the beginning of a lifelong journey of continuing medical education.
He lets on that it was not easy when he first started out in his medical career.
'I'll never forget how I was terrified as a trainee, because all the drugs are so potent. And when I spoke to my first patient, I don't think my explanations were in layman's language.'
With a relentless stream of patients to treat, it was imperative to learn how to focus on each individual, he adds.
'Every 15 minutes a new patient is coming in. You must be able to give your full attention to each person, and to bounce back.'
The professor counts pathologist K. Shanmugaratnam, 88, as a great source of inspiration.
'At 88, he is still as passionate as ever, loves his craft, keeps up to date, and is a fantastic teacher and great mentor. Pathologists go to him for a second opinion. He's a living legend.
'It's hard for me to quit or feel tired when I see him still in the saddle at 88.'
Alongside this passion for training, is a quest to push the boundaries of research. He was initiating efforts to improve treatments for cancers common here and the region even before the life science push a decade ago.
His simply furnished NUS office has been the site of many recruitment successes, where many big names in research have been persuaded by him to come and work in Singapore.
Institute of Molecular and Cell Biology chief Neal Copeland - then with the US National Cancer Institute - used to drop in on his visits to Asia, with his research partner and wife Nancy Jenkins, and was persuaded to move to Singapore.
Prof Wong, along with NUS president Tan Chorh Chuan and former Biomedical Research Council executive director, Dr Kong Hwai Loong, were affectionately termed the three musketeers by Singapore's biomedical champion Philip Yeo, for their efforts in spearheading Singapore's life sciences initiative with him, and helping to transform Singapore into a biomedical hub.
With the Fusionopolis and Biopolis research centres overlooking his NUS office, he jokes that Mr Yeo, who is head of Spring Singapore, and Agency for Science, Technology and Research (A*Star) chairman Lim Chuan Poh are watching over him from there.
Prof Wong admits that his work sees him putting in long hours and acknowledges that he has a punishing schedule to keep to.
'I'm trying to ease up a bit. I had to go and see a patient at 3am the other night and I felt it the next day. I tend to get cranky if I sleep under 51/2 hours, and my blood pressure goes up. But when I sleep, I sleep very, very well.'
He misses playing squash, and has not got the time to play golf like some of his doctor friends because he does not have 'four hours to spare to go to the golf course', but does admit to enjoying a glass of wine from his decently stocked cellar.
His biggest regret about working such long hours is that he does not spend as much time as he would like to with his wife and two children - a daughter, 18, and son, 16.
'They ask me sometimes, why I can't be a 'regular doctor'. But I feel that if our system needs help, I have to pitch in,' he explains.
'This is my national service.'
Cancer and blood diseases expert
PROFESSOR John Wong, 52, is dean of the Yong Loo Lin School of Medicine at the National University of Singapore (NUS).
He is also the deputy chief executive of the National University Health System, which brings together the National University Hospital (NUH) and the NUS medical and dental faculties.
Prof Wong is director of the National University Cancer Institute, Singapore.
A medical oncologist- haematologist, he specialises in cancer and diseases of the blood.
In 1997, he formed the Cancer Therapeutics Research Group, which brought together cancer centres here and in Australia, Hong Kong, Korea and Taiwan to develop better treatments for cancers.
It has since conducted clinical trials on new cancer drugs and worked to fine-tune the dosage of cancer drugs to suit different ethnic groups here.
Prof Wong led a group doing research into H1N1 this year. In 2003, he headed a consortium of local laboratories and researchers during the Sars crisis. This collaboration led to the development of diagnostic kits for the Sars virus.
Earlier this year, he received the National Outstanding Clinician Award from the Health Ministry, in recognition of his contributions to medicine and clinical research.
He is married with a daughter, 18, and a 16-year-old son.
This article was first published in The Straits Times.