The Ministry of Health (MOH) announced in a media statement on Thursday (14 March) that it has appointed a workgroup to do a comprehensive review of the Singapore Medical Council’s (SMC) disciplinary process, as well as the taking of informed consent by doctors.
The 12-member workgroup comprises medical and legal professionals as well as laypeople, and represents a mix of interests and backgrounds. The three professional medical bodies (Singapore Medical Association, College of Family Physicians Singapore and Academy of Medicine, Singapore), which represent almost all the doctors in Singapore, are represented on the workgroup by their respective heads.
The workgroup will canvass the views of medical practitioners from across a diverse practice background as well as the public, in coming to its views and recommendations. It is expected to complete its work by end of 2019.
Its co-chairperson Kuah Boon Theng said, “When doctors have the benefit of clear practical guidance on how best to serve the needs of their patients, this can only benefit the public.
“One of the areas of focus will be on informed consent, to help find the right balance, so that it is meaningful to patients and doctors.”
SMC applied to more time to appeal
At the same time, the SMC has applied to the High Court for more time to appeal against the decision of a disciplinary tribunal to fine a doctor $50,000 for not verifying the identity of a caller before handing over the memo containing a patient’s confidential medical condition.
In this incident, Dr Soo Shuenn Chiang, who was an associate consultant psychiatrist at the National University Hospital (NUH) at the time of the occurrence in March 2015, had given a memo on a patient’s medical condition to a caller who said he was her husband. He added that he needed the memo to move her to the Institute of Mental Health, as she was suicidal.
The man was in fact her brother, and he used the memo to take out a personal protection order against the patient. She filed a complaint to the SMC against the doctor. The SMC had asked for a $20,000 fine, but the tribunal set it at $50,000, saying that patient confidentiality is sacrosanct.
The tribunal’s judgment prompted a petition signed by nearly 9,000 doctors, who expressed their unhappiness at the heavy fine. They saw it as a big step backwards in how they care for patients. The petition added that doctors might no longer dare to speak to a patient’s caregiver for fear of reprisals, in case doing so is seen as a breach of confidentiality.
Petition against fine for not telling patient of side effects
This is the second time this year that the SMC, Singapore’s medical profession watchdog, has applied for more time to appeal against the disciplinary tribunal decision. In both cases, the time for either side to appeal had passed.
In February, another tribunal had fined another doctor $100,000 for not telling the patient about the side effects of a common steroid injection. SMC had asked for a five-month suspension.
Again, there was a protest by doctors who argued that many of them do not tell patients of side effects that are rare and transient. They added that, if they need to tell patients of all the side effects of all the medication they are prescribing, it would be an information dump of little use to patients.
The SMC said its application for this case to be reviewed has been granted, and a hearing by a Court of Three Judges is scheduled for the second quarter of this year.
Note to provide greater clarity to issues
MOH will work with SMC, the three professional medical bodies and the public healthcare institutions to formulate a practise note to augment the 2016 SMC Ethical Code and Ethical Guidelines. The note will provide greater clarity on patient confidentiality issues when communicating with patients’ next of kin.
The SMC has also set up a Sentencing Guidelines Committee in January to help tribunals arrive at appropriate penalties.
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