OPENING ADDRESS BY DR BALAJI SADASIVAN, MINISTER OF STATE (HEALTH & ENVIRONMENT) AT THE ASIA-PACIFIC REGIONAL CONFERENCE 2002 ON ‘PATIENT EDUCATION – NECESSITY OR NICETY?’ HELD ON FRIDAY, 26 JULY 2002 AT MANDARIN HOTEL AT 9.00 A.M.

Mr Tan Tee How, CEO, National Healthcare Group

Mr Chua Song Khim, CEO, National University Hospital

Distinguished Guests

Colleagues

Ladies & Gentlemen

If I had been asked, as a medical officer in the 70s, what patient education was, I would probably have replied that it was explaining to the patient what his disease condition was and what needed to be done. A patient in those days would likely have accepted what I said, taken whatever medication that was prescribed, and submitted meekly to whatever procedures needed to be done, perhaps without even a question.

That was in the past when information and management lay mainly in the hands of the health care professional. Decisions were made for the patient. Information and instructions were given on the assumption that the patient would faithfully carry them out.

However, by the early 80’s, public health practitioners in Singapore recognised that providing information alone did not necessarily lead to the desired health behaviours. Studies showed that between 40-80% of patients did not carry out all the instructions given to them to restore or maintain their health.

Chronic degenerative conditions were becoming the leading killers in Singapore and many other countries. With this emerging trend, it became clear that medications alone was not enough to reduce one’s risk of developing these conditions or managing them adequately. Increasingly the important role of lifestyle changes in reducing risk and managing chronic conditions became recognised. New and more innovative strategies were needed to bring about behaviour change.

In Singapore, a Patient Health Education Unit was set up in the Ministry of Health in the mid-80s to encourage patients and their family members to take personal responsibility for their health and to become active partners in promoting health and preventing disease and their complications. Programmes and educational materials were developed to encourage health care professionals in the public and private sectors to conduct health education in clinical settings as well as to provide condition-specific counseling for their patients.

As a result of these efforts, most hospitals in Singapore today have a patient education department that provides patient education as an important component of the overall management of major chronic diseases. The government polyclinics also provide patient education for a variety of conditions.

The socio-cultural changes that have taken place in Singapore over the past 2 decades has made the situation today very different from when I was a medical officer. Patients are now more educated and much more knowledgeable about health matters in this internet age where information is so accessible. There is greater patient participation in health care decisions. Patients are also concerned about the costs of treatment. Patients’ expectations of health care services have risen. In the area of communication and patient education, research indicates that 30-60% of patients feel that information received from their health care providers could be considerably improved.

To address the challenges of these changing times, the goal of patient education remains the same, which is to promote patient compliance with risk reduction and treatment recommendations. However, the mindset of health care professionals also needs to change. Health care professionals need to take a more discussive approach, and strive to provide not just technical information but encourage patient choice, patient participation and patient responsibility for health behaviour. Health care professionals need to view themselves as not just a healer or caregiver, but as an educator and a partner in health care.

Although many health care professionals recognise the importance and benefits of this approach, few may actually practice this often or well enough. One of the most important barriers to this is a lack of training. Most health care professionals have no formal training in patient education -- a complex process requiring skills like rapport-building, assessing learning needs and readiness to learn, and planning teaching that best suits the patient’s needs. Patient education also requires effective skills in communication, use of appropriate teaching resources, assessing potential barriers to treatment recommendations, and problem-solving besides having sufficient knowledge about the subject matter.

Another barrier is the myth that patient education takes too much time. There may seem to be a lot to do in the short consultation time that most health care professionals have with their patients. However, with sufficient training and practice, effective patient education does not necessarily take much longer than a usual consultation.

So my challenge to you today is 3-fold.

Firstly, equip yourselves with the necessary knowledge and skills in effective patient education.

Secondly, convince other health care professionals of the importance of effective patient education, and assist in equipping them with these skills. This can be achieved by encouraging the teaching of patient education skills in undergraduate, postgraduate and continuing professional development courses for all health care professionals.

And finally, make a point to regularly exchange information, experience and research in patient education with one another through informal and formal local, regional and global networks of patient education practitioners.

I would like to take this opportunity to commend the National University Hospital for its commitment to further improve the practice of patient education by organising this conference, and I hope to see many more such conferences in the future.

It now gives me great pleasure to declare this conference open. I wish all of you a stimulating and enjoyable time together.

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