Telemedicine in Singapore and Beyond: Transforming Obstacles into Opportunities to Augment Healthcare Provision

This article was exclusively written for The European Sting by Wang Jia Dong James and Loh Pei Yi, first-year medical students at the Lee Kong Chian School of Medicine (Nanyang Technological University – Imperial College London), Singapore. They are affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

At a recent medical conference, Singapore’s Minister for Manpower Dr Tan described telemedicine as “another line of healthcare defense”. From 24-hour mobile applications, regional medical centers to tele-kiosks within dormitories, Singapore’s slate of initiatives for migrant workers highlights the increasingly existential need to combat invisible adversaries lurking insidiously in society. The prevalence of telemedicine has skyrocketed in Singapore’s fight against COVID-19, most markedly, leveraging home recovery programmes to prioritize healthcare resources.

To many of us, telemedicine only became common-term during the pandemic. However, telemedicine had already bloomed since the digital revolution. It was only during the pandemic when much attention was cast upon it, as it promised to solve some of the most pressing needs in healthcare…

Telemedicine has uncovered opportunities to improve healthcare delivery as it reduces the risk of contracting infectious diseases and creates greater ease for patients with stable conditions. One could compare telemedicine to the Hill-Burton Act [1] which revolutionized healthcare delivery: previously, hospitals were filthy places acting more as quarantine centers than as places of care. Telemedicine, by providing care at the patient’s home, further reduces the risks associated with hospitals, providing safer and more efficient care.

Furthermore, telemedicine’s benefits towards healthcare accessibility – corroborated by the migrant worker community in Singapore – present opportunities for connecting patients to doctors. This could be best utilized in Southeast Asian countries like Indonesia where there are 17,508 islands with only 2,344 hospitals [2]. Providing adequate medical care physically is highly unfeasible due to the vast physical disparities, which telemedicine seeks to reduce through digital adoption. 

The convenience created by telemedicine, on the contrary, has presented challenges in the precision of diagnosis. For patients with cardiovascular complications, a doctor over telemedicine simply does not have the tools to perform proper auscultation or ECGs, yet it would be equally unfeasible to have patients own such equipment at home or construct highly expensive, complex telebooths for patients to tap on [3]. 

In Singapore, the lack of transparency regarding doctor selection in telemedicine has led to adverse selection, where the dearth of differentiation between doctors further exacerbates patient-doctor information asymmetry. This leads to a death spiral, whereby patients anticipate the lowest quality, causing better-performing physicians who command higher rates to leave the market. With only “lemons” remaining, it would be ludicrous to expect telemedicine to replace higher-quality medical consultations.

Arguably, in an age of social distancing, building doctor-patient rapport is the greatest challenge telemedicine presents. The outrage sparked from a Californian doctor breaking bad news of a patient’s imminent death through teleconferencing [4] underscores the indispensability of the human touch in medicine, to provide patients with empathy and dignity beyond treating their medical ailments.

Ultimately, the sustainability and viability of telemedicine in Singapore and the greater global context is contingent on transforming current obstacles into opportunities as diagnosis methods become more portable and cost-effective, along with algorithms to combat adverse selection. While telemedicine is unlikely to fully replace physical patient-doctor interactions, there remains cause for optimism for it to augment healthcare.

References

[1] Schumann JH. A bygone era: When bipartisanship led to health care transformation [Internet]. NPR. NPR; 2016 [cited 2021Dec25]. Available from: https://www.npr.org/sections/health-shots/2016/10/02/495775518/a-bygone-era-when-bipartisanship-led-to-health-care-transformation

[2] Statista. Indonesia Hospital number by type 2019 [Internet]. 2019 [cited 2021Dec25]. Available from: https://www.statista.com/statistics/605535/number-of-hospitals-in-indonesia/

[3] Milton. Three reasons why healthspot died [Internet]. VSee. 2016 [cited 2021Dec25]. Available from: https://vsee.com/blog/three-reasons-why-healthspot-failed

[4] Brown S. Preserving the human touch in medicine in a Digital age. Canadian Medical Association Journal. 2019;191(22).

About the author

Wang Jia Dong James and Loh Pei Yi are first-year medical students at the Lee Kong Chian School of Medicine (Nanyang Technological University – Imperial College London), Singapore. Pei Yi is currently Director of National Programmes of the Asian Medical Students’ Association Singapore (AMSA SG), a constituent of the International Federation of Medical Students Association (IFMSA). Jia Dong is a founder of a local telemedicine firm and has been a strategist at one of the major private healthcare providers in Singapore, overseeing and evaluating the group’s strategies in telemedicine.