​It is a privilege when patients open up, sharing thoughts they have barely dared to articulate to themselves, about their preferences for medical and nursing care when their condition deteriorate. Dr Janet Ong tells us more.


A special tribe
Each year, we refer hundreds of patients to the SGH Advance Care Planning team, to think about and document down how they wish to be cared for when their health deteriorates. But only about a third of these patients eventually complete an Advance Care Plan. It is clear that not everyone is ready.

Resident Physician Dr Janet Ong, who has been with the ACP team since 2015, considered those she has met quite a special group of people. She looked forward to each session of facilitation with patients, as no two patients have ever come across as similar.

Dr Janet commented that, “As it’s usually impossible to compartmentalize one’s physical ails from the rest of one’s life, I feel that it is a privilege when patients open up, sharing thoughts they have barely dared to articulate to themselves. I hope I have been able to help them wade through their thoughts about preferences for medical and nursing care when they deteriorate. Knowing what to expect makes everything less frightening and offers some sense of control.”

Memorable patients encounter
Often the ACP conversations take some courage on the part of the patients, and the respect she has seen some family members have for their loved ones’ wishes and thoughts have been edifying.

“One patient declared that he felt so liberated when he understood that he did not have to accept all the treatment his doctors offered him; he just wanted to be made comfortable in his advanced age.

Perhaps the most uplifting patient I’ve met was a father of three in his late 40s, who has chronic osteonecrosis of the base of skull bone post-radiotherapy for Stage 3 nasopharyngeal cancer.

Every step he took sent a little spike of pain to the back of his head. Yet he could still laugh when he related how he once ran for the bus, and had to be in bed for 3 days afterwards due to a massive headache!

His take on life was that he could not ask for more: he has had a good life with a loving family and now that his sons have completed their studies, he feels fulfilled and will not be “greedy for more”, shared Dr Janet.

What ACP really is
Dr Janet said, “When family and friends ask what I do at SGH, most seem to appreciate that ACP is a great idea, and are often surprised that the hospital offers such a service. However, ACP is often classified as part of end of life care, “helping people to die”. I hope someday it could be better seen for what it is – helping people to live well up to the very last.”

To facilitate ACP, clinicians can now make both inpatient and outpatient ACP referrals via Computerised Physician Order Entry (CPOE) in SCM. Find out more on the ACP referral process here. (accessible via Infopedia)

Why does she choose to do this work?
“Back in 2015, over coffee with Associate Professor Chow Wan Cheng (who was then Chairman, Division of Medicine), she popped the question about helping out with the incipient SGH ACP team. I had recently started doing part time GP work after a hiatus of about 12 years from clinical work, and was intrigued by her offer.

During my Internal Medicine training days in SGH, building a relationship with patients and their families especially towards their last stages of their illnesses had left the deepest mark for me. I realized that I enjoyed the human element of it as much as if not more than I did the medical challenges. So the ACP proposal did seem like a great fit. After I met the team and its dedicated members, and had gotten accredited for the job, I was sure that I was definitely in the right place”, recounted Dr Janet Ong.

SGH Advance Care Planning Workgroup is hosting a series of lunch time webinars to share insights and strategies in promoting and facilitating advance care planning for patients. In this first webinar on 18 May, they have invited an expert panel of clinicians and a bioethicist to clarify key ethical considerations relevant to advance care planning. Register here https://for.sg/advancecareplanning for this free webinar.

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