Taking multidisciplinary practice to a higher level and enabling subspecialties across Academic Clinical Programs (ACPs) to come together under one umbrella, are the two pioneer SingHealth Duke-NUS Disease Centres which are operating as cluster-level clinical entities.

In a traditional hospital setting where departments are specialty-based, patients would be referred from one department to another to see different specialists. But with this new approach, the specialists will go to the patients.

Leading the SingHealth Duke-NUS Head and Neck Centre since 1 March is Dr Tan Hiang Khoon. He said, “Head and neck surgery is very complex as it involves a mixed group of conditions handled by clinicians from different institutions and base specialties – from general, plastic, ENT to oral and maxillofacial surgeons. No single clinician can have the full spectrum of knowledge.

“With a centre that is disease-based like ours, there are no longer any borders. The new structure provides a spectrum of complementary skill sets from different clinicians across specialties and institutions that are now grouped in the same together.Patients can thus enjoy integrated care.”

Dr Ong Kong Wee, Head of the SingHealth Duke-NUS Breast Centre, also emphasised, “The freedom for both patients and physicians to move between institutions is a small but extremely significant step in promoting collaboration among stakeholders, as well as in breaking down traditional healthcare barriers.”

The manpower and hours saved with this new model of centres allow doctors to focus on more complex or urgent cases.  Taking from his experience in Duke Durham, Professor Thomas Coffman, Executive Vice Dean of Duke-NUS, supports the patientcentric care model.

He said, “This approach is particularly effective for cancer patients, who are typically cared for by multiple specialists including surgeons, oncologists and radiation therapists. It has also proven its value in other areas including cardiovascular medicine and organ transplantation.”

He listed the benefits: “First is the convenience for the patient of being able to see all of their doctors in the same place.   Second is the significant opportunity for coordination of care between the various specialist teams. Finally, this kind of team approach facilitates improvements in processes of care and promotes an atmosphere of collaboration that positively impacts clinical care and opportunities for research.”

Dr Ong echoed similar sentiments, “Rather than focus on our own areas, we hope to address patients’ problems in one location where the medical team revolves around the patient. Presently, sub-specialisation is necessary from a medical point of view because the explosion of knowledge and the increasing pace of innovation demand it.

“But this also means that general problems tend to be less defined and patients can require more than one doctor for a particular set of issues. We are essentially putting the patient in the middle and placing the whole medical team that will adequately address his needs around him.”

Dr Ong highlighted that with the organic nature of the Breast Centre, patients can now avoid repeated tests and delayed treatment.   Every patient with breast issues is a potential end-user of specialised equipment no matter where it is housed.

“More complex procedures usually involve more than one doctor. With the new centers, the patient can stay in the institution she visited for pre-operative treatment and counselling, moving only for actual surgery, and returning for post-operative treatment and surveillance at the first institution she visited, Dr Ong enthused.

The cluster-wide Head and Neck Centre will focus on multidisciplinary head and neck pathology and provide an overarching responsibility for six core competencies, including Oncologic TransOral Robotic Surgery (TORS) and endoscopic/robotic skull base surgery; paediatric head and neck surgery; as well as oral rehabilitation and prosthodontics.

With a single referral channel, patients can now move seamlessly from SGH to NCCS for their treatment. They may also have more appointment dates to choose from.

For clinicians, the collective expertise offered by the new department means that individuals can benefit by exploring deeper into their subspecialties.   The Centre can also pick the best practices from its range of skill sets for a particular disease to benefit patients with the best possible treatment available.

Dr Tan said, “In terms of training and education, the concentration of subspecialty cases provides rich clinical material.   “The increased repertoire of the faculty expertise offers unique learning experiences across all stages of academic learning.” Research also gains from the new Center’s combined clinical volume and streamlining of resources.   Collaboration is made easier for all aspects of research work, hence enhancing basic bench work, translational research and even clinical trials.

“With the manifold benefits of our clusterlevel center for our patients, clinicians and research colleagues, it is very likely that we can look forward to more of such new structures,” said Dr Tan.