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Caregiver Confidentials: A Day in The Life of a House Call Doctor

[fa icon="calendar"] Jun 23, 2016 2:25:39 AM / by Friends of CaregiverAsia

Dominic Zhou scored the enviable opportunity to speak with Dr Lai in depth about his caregiving portfolio.

Dr Lai Junxu is certainly no dyed-in-the-wool traditionalist. His professional portfolio runs the gamut from traditional hospital care to emergency medicine to family medicine and aesthetics to medical informatics and now, home care. Most importantly, Dr Lai is forward-looking and an advocate of the future: integrating telemedicine into home care for the aging community.

Sitting in a café in the central part of Singapore, Dr Lai, in his early 30s, cut a casual, dapper figure when he chatted with CaregiverAsia (CGA). However, things became a lot more serious, yet somehow strangely exciting, when he got interrupted by a call from a patient’s daughter. Five minutes later, the patient herself called him, and he switched languages to explain things to the patient. Calm and reassuring, Dr Lai does more than just ooze care and confidence. He projects "presence" – and he does this with the help of technology. He replies to urgent texts and instant messages as soon as he can, even at traffic lights!

Image of Dr Lai, the healthcare futurist.

  • A House Call Doctor's Day

As a house call doctor, Dr Lai's regular day often starts with either a planned home visit, where there are fasting blood tests to be taken, or an emergency case that emerged through the night. And in between, he answers calls of various nature from new queries to medical advices to referrals, whilst replying to less urgent emails and messages later in the day. For ease and efficiency, the busy doctor groups his cases by geographical location as well as carries around six folders for his six groups of patients. His patients are categorized under subsidized home care program, subsidized palliative home care program, post-A&E discharge home care program, and private home cases. Somewhere in the mix, Dr Lai also taxi his children to and from childcare everyday. Though Dr Lai is on call 24/7, his regular day usually ends with him updating his patients' clinical notes and "replenishing" his medical bag, all topped up and ready for the next day. 

  • Helping Families Plan Their Health
Dr Lai explained that the first initial visit is crucial as it sets the tone for the goals of care as well as the expectations of all parties involved. In order to plan a family's health, Dr Lai usually pores through the available medical history, medications, and memos before instructing them to undergo a general head-to-toe examination as well as physical examination.
According to the doctor, the plan usually involves determining whether the patient is for maximum home care, trial of home care before sending to A&E, or home visit as an adjunct to specialists visits. The plan also entails the "prescription of relevant standby medications so that the patient and/or the next-of-kin will have a set of ready-to-use medications", should the patient have an acute medical issue. As part of the plan, Dr Lai also schedules follow up home visits as well as any regular routine investigations that need to be done. As a considerable proportion of his patients require end-of-life care, advance care planning or broaching the topic of preferred place of care or death is quintessential.
  • The Tech Doctor

For Dr Lai, technology is not a buzzword. It is a workhorse. Dr Lai’s practice covers a wide range of general practice services, including using telemedicine to ensure that the patient’s entire range of needs is met. Dr Lai handles a stable of affiliated service providers such as nurses, physiotherapists, occupational and speech therapists and even ambulance providers. He leverages heavily on telecommunications technology to maximize the impact of service delivery, not to mention, increase patient convenience and cut costs.

Dr Lai’s journey into his current unique business model started when his grandmother passed on from liver cancer. His family faced huge difficulties getting a doctor to provide home care for her. Inspired by a senior doctor, he realized that the mechanics were easy to set up. However, the problem lies in getting suitable patients to agree to home care as well as a suitable subsidy or co-payment model. 

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This is why Dr Lai embarked on a journey to provide the full suite of care services, and continues to explore ways to achieve this. “My dream is that I can see you at home or at a clinic, then at a hospital if the need arises, and at home again after you are discharged. A primary healthcare physician should be the cornerstone of managing and coordinating a person’s medical matters,” he explained with determination.

Dr Lai believed that home care is definitely a growth area. After all, the silver tsunami is here, and the Singapore Government is now encouraging General Practitioners to offer home care. However, Dr Lai believed the key to achieving this is to judiciously extend subventions to home care and related areas, and the doctors will follow. This is because for doctors, it is more rewarding to handle the more complex cases, and also to extend treatment to more people who normally cannot afford complex treatment under non-subsidized rates. However, medical subsidies do not always extend to areas outside the brick and mortar of hospitals and clinics.

  • The Futurist

Dr Lai believes we should optimize the home environment, via technology if necessary, to ensure patients get optimal care at optimal "social" cost. This is where subsidies come in. The target here is to achieve a cost-efficient allocation of human medical resources: why tie up a geriatrician for two hours on one home visit when he can handle more cases at his or her specialist clinic? The home care doctor can do the home visits, communicate with and work hand in hand with the hospital-based specialists to keep the patient well! When Dr Lai discussed these matters with CGA, he demonstrated a keen understanding of not just the economic ins and outs of the industry, but a working knowledge of structural macro-economic issues. All this, while providing his patients with the personal, human touch through telephone. All in all, the problem Dr Lai seeks to solve is not easy – it needs all stakeholders to buy in and co-operate. Legal regulations, institutional mindsets, insurance incentives, pharmacological commercialization and logistical platforms – Dr Lai discussed with CGA all these issues and more, with the enthusiasm that has seen his practice grow so quickly in such a short time.

We at CaregiverAsia wish Dr Lai well in his current and future endeavors!

Want to speak to or book a consultation with Dr Lai, call CaregiverAsia at +65 6258 6683 or click below for a care service!

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And with this, we hope to continue to spread the word on the help that is available for Careseekers as well as an open invitation for experienced Caregivers to join the CaregiverAsia community. Caregivers who post services on the CaregiverAsia website practice 100% of their own terms, right down to their availability, and service costing. There are no subscription fees or posting fees for Caregivers. There are many people looking for care services now, so do sign up online on our website, or call +65 6258 6683 to talk to us.

Topics: Caregiver Confidentials

Friends of CaregiverAsia

Written by Friends of CaregiverAsia

Friends of CaregiverAsia are accomplished professionals in their fields as well as dedicated caregivers. When not busy making a positive impact on their surroundings, friends of CGA gratify others with their insightful and heartwarming stories.

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