Advance care planning (ACP) is a core tenet of personcentred care in serious illnesses. Family physicians provide relationship-based and continuing care. These are key in the endeavour to understanding our patients’ healthcare preferences in serious illnesses. This is especially salient in an ageing population where people may experience cognitive and functional decline in their last years and modern medicine struggles to provide person-centred treatments. With the recent healthcare reform and Healthier SG, challenges and opportunities abound for family physicians in serious illness care. As co-creators of personalised care plans with each enrolled resident, primary care physicians will play an increasingly important role in ACP. The COVID pandemic has made stark the reality that anyone can suddenly and seriously fall ill at any time. The need to address this elephant in the room makes ACP urgent and relevant, especially today.