Anyone who has lived through the past year and a half will have a story to tell about COVID-19. The pandemic has upended the world, causing massive death, injury, unemployment and more; it's hard to imagine a more globally impactful event in recent memory. On a personal level, all of our lives have ground to a halt, as work-from-home and social distancing have necessarily become our new normal. With this upheaval, however, has come an opportunity to examine more closely the industry in which we will all work someday, and identify the changes catalysed by such an unprecedented crisis.
Our experience with SARS was retrospectively a boon during COVID-19, as it provided us insight on the holes in our healthcare system we needed to fill. As we students approach the end of our academic year, and our M5s prepare to graduate, it seems an appropriate time to be cognizant of the lessons learned from this pandemic, take stock of the paradigm shifts happening in healthcare and speculate on how they might impact the Singaporean medical scene in the near and distant future.
Telemedicine and Digitalisation
The movement towards telemedicine and the digitalisation of care is arguably the greatest – and definitely the most obvious – effect of the pandemic on healthcare so far. Digital health consults were, in many places, on the precipice of being implemented by healthcare institutions (1), but COVID-19 has accelerated that timeline. With the urgent need for social distancing to quell the spread of the virus, many non-critical treatments and consultations were put off until a less precarious time (2). However, in areas which had the resources and infrastructure to adopt alternative means of connecting patients and healthcare workers, telemedicine became the new standard (3). Where they could, countries introduced online consultations, virtual health screenings and socially-distanced check-ups to completely replace face-to-face interactions (4).
In Singapore, the pandemic prompted a rapid escalation in adopting new and relatively innovative models of care. Tamping down on community spread was and still is a significant priority, and one way to do that was to prevent hospitals and clinics from becoming hotspots for infections by cutting back on non-essential interactions. For instance, the National Kidney Foundation and the National University Hospital coordinated an effort to cease in-person dialysis rounds in February 2020, replacing them with remote reviews of patient records and online communications with on-site dialysis nurses (5). The Ministry of Health further encouraged the digital healthcare boom by approving video and phone consultations with some limited and conditional coverage from Medisave (6).
It is difficult to tell precisely how and how permanently telemedicine will be integrated into existing healthcare platforms, and the role it will play alongside in-person consultations in the future. However, it is not an unreasonable assumption that it will be more extensively implemented following its widespread use and relative success in delivering adequate care during this pandemic (7), and we can likely expect telemedicine to be a routine part of healthcare in the future.
A Shifted Focus to Holistic Healthcare
One of the more notable trends in healthcare in the 21st century is the push for a greater emphasis on non-physical health issues. Mental health was a key theme in the Sustainable Development Goals and was thus brought to the forefront of the recent unified global agenda (8). COVID-19 has now thrown these illnesses into even sharper focus – while it may be a respiratory virus, it has also triggered a mental health epidemic, with reported cases of anxiety and depression approximately quadrupling in the last year alone (9).
The context of near-total isolation has become almost universal as a majority of people are forced to stay home and avoid interaction to contain the spread of the virus. This has led to an avalanche of mental health issues stemming from the inherent loneliness of work-from-home and social distancing (10) and the existential loss and fear created by a spike in unemployment and the generally dismal state of world affairs (11). Moreover, many people now lack their typical emotional outlets e.g. sports or travel, leading to a build-up of stress and emotion without catharsis, which exacerbates the issue (12). The pandemic has created a perfect storm for mental illnesses and caused many to spiral downward into anxiety, depression and more (13), and this problem is affecting every section of society. There has been a significant rise in those seeking help for mental health issues in Singapore across all age groups since the pandemic began (14).
In response, many communities have been calling for a greater emphasis on mental health in national health strategies to combat these trends, although there have yet to be any national guidelines on specifically supporting the mental health outbreak during COVID-19 in Singapore (15). However, mental health will continue be a predominant issue in the healthcare arena, both globally and locally, as this wave of mental illness will endure even years downstream of the pandemic (16). Healthcare workers in the future will need a solid grasp of how to navigate mental as well as physical illnesses in patients in order to address these increasingly prevalent health issues.
Medical Tourism
In keeping with the trends of globalisation and greater international collaboration, medical tourism has become a major industry in the last few decades. Singapore is one of the world’s top destinations for medical tourism – we rank #2 globally on the Medical Tourism Index (17). In recent years, the practice of encouraging citizens of other nations to travel to Singapore has been somewhat controversial, at least in the public sector; 2019 saw the Ministry of Health cracking down on public healthcare institution contracts with foreign agents who facilitate visits by foreign patients (18). In the same year, the Singapore Tourism Board confirmed it was no longer pursuing medical tourism as a travel strategy (19).
While medical tourism was in the process of being weaned down in the public sector even prior to COVID-19 (20), it was still a popular practice in private healthcare institutions (21). The near-total shutdown of the travel industry following the pandemic means that medical tourism has temporarily but completely ceased. Many private healthcare institutions were more heavily impacted by this as some have lost a majority of their overseas patients (22).
It is possible that the last year without business will kill both the private and public medical tourism industries permanently and make Singapore a far less common destination for foreigners seeking treatment. Whereas this may be a relatively minor impact on public healthcare, it could be quite a drastic change for some private healthcare institutions which cater to this clientele. However, conjecture on the eventual outcome of medical tourism as a niche industry in Singapore is still wholly speculative – medical tourism could pick up again when borders reopen, but in the meantime, it is a significant adjustment for many healthcare institutions.
In Singapore, the light at the end of the tunnel is dim but visible. The progression to Phase 3 and the reopening of most in-person businesses has allowed us to return to a fragile new normal. It's ordinary to be pessimistic about the ramifications of a pandemic when we only recently passed the peak of this healthcare crisis, but upheaval catalyses radical change, and not all of it is bad. Discerning the positives from the negatives will require more hindsight than we have at present, but we should be aware of the rapid evolution of the medical industry during and following this pandemic. The next pandemic could very likely happen while most of us are still practicing, but hopefully this experience has prepared us adequately for that.
By Beth Jacob-Chow (M3)
References
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