WHAT TRULY COUNTS

Mdm T’s and Mdm X’s stories ended well, others may not. 

But in every case, however, the goal of medicine remains the same: to act with integrity, compassion, and respect for the patient and those to whom he matters. 

Success should not be measured by clinical metrics alone. Relational value, built through thoughtful conversations, must also be acknowledged. Crucially, the quality of decision-making itself must be recognised as part of value.

Perhaps the formula needs rethinking. Rather than judging value solely as outcomes divided by cost, the framework should also account for how and whether a rational decision was made – one that was appropriate based on evidence, guidelines and the patient’s context, one aligned with the patient’s care goals, and one in their best interest. 

Such a shift would protect clinicians from being penalised for uncertainty. More importantly, it would protect families from being burdened by hindsight guilt, and patients from being reduced to data points.

The pursuit of value in healthcare is not only pragmatic but necessary and noble. A healthcare system must care about outcomes and cost, but it must care about more than that. 

In their hardest decisions, “appropriate” and “value” won’t actually mean much to patients and their families. It is how they are helped to make choices they deem most reasonable and how they are treated with honesty, respect and dignity that will matter most.

Dr Faisal Johandi is Associate Consultant in the Department of Geriatric Medicine, Khoo Teck Puat Hospital (KTPH). He is also Honorary Secretary of the Society for Geriatric Medicine, Singapore.

Assoc Prof Philip Yap is Senior Consultant in the Department of Geriatric Medicine, KTPH. He is also Chairman of Dementia Singapore.

Assoc Prof Tan Kok Yang is Senior Consultant in the Department of General Surgery, KTPH. He is also President of the Geriatric Surgery Society, Singapore.