Looking after interests of patients, medical community

MOH’s Reply

We thank Dr Huang Shoou Chyuan for his letter (Doctors may be losing confidence in SMC's self-regulatory process, April 2).

The Ministry of Health (MOH) shares the concerns of the medical community on the issues raised.

Health Minister Gan Kim Yong had on April 1 clearly stated in Parliament MOH's position.

We reiterate a few points here.

Patient safety and welfare remain the ultimate goal of our healthcare system. This also means that the standards required of doctors need to be clear, and well-defined.

We recognise that more can be done, and MOH has set up a 12-member workgroup to review the legal and practical applications of taking informed consent and make recommendations on clear practical guidelines.

The workgroup will consult widely, and has been given the mandate to be comprehensive and thorough in its review.

In addition, to address the concerns, including those raised by Dr Huang, concerning the transparency and fairness of the disciplinary process and outcomes, this workgroup will also review the Singapore Medical Council's (SMC) complaints and disciplinary process, and recommend changes to improve the medical profession's professional regulatory processes.

The practice of medicine is built upon the mutual trust and respect between doctors and patients, and the highest possible standards of professional practice.

We will continue to work with our healthcare professionals for greater clarity and balance in the practice and processes in the medical community, so as to enhance patient safety and keep overall healthcare costs affordable.

Lim Siok Peng (Ms)
Director, Corporate Communications
Ministry of Health  

Forum Letter

The Straits Times, 2 April 2019

Doctors may be losing confidence in SMC's self-regulatory process

In more than 35 years as a doctor in Singapore, I have never felt more despondent as now and I am certainly not alone in losing confidence in how self-regulation is administered by the Singapore Medical Council (SMC).

Three recent SMC cases have shocked doctors:

• A 2017 case when paediatrician Chia Foong Lian was suspended for three months for missing a difficult diagnosis;

• A case this year when orthopaedic surgeon Lim Lian Arn was fined $100,000 for failing to tell his patient that a steroid injection could have side-effects such as discolouration of the skin; and

• A breach of confidentiality case this year, when psychiatrist Soo Shuenn Chiang was fined $50,000 for writing a memo to get a patient admitted to the Institute of Mental Health.

What followed were unprecedented petition drives by the hitherto conservative medical professionals, who signed three petitions consisting of 1,000, 6,400 and 8,400 signatures in the three cases respectively.

The doctors I know who signed the petitions are serious-minded people who do not put ink to paper lightly as their professional reputations are at stake.

The Ministry of Health formed a work group last month to review the taking of informed consent and the SMC disciplinary process.

How do I want medicine to be practised in Singapore?

• In good faith, I will use all my skills and knowledge to help every patient. Many diagnoses may initially remain elusive, but this is not necessarily negligence.

• Many treatments and medications have known complications that are often unavoidable. I may not have the time to explain every one of these complications, nor do I feel that I have to.

• Patients are often treated as part of a family unit and I have always shared relevant knowledge with their loved ones for them to make collective decisions.

• Our courts have reiterated that the Bolam-Bolitho test is relevant in measuring a doctor's action during diagnosis and treatment. Briefly, this test says that if the doctor's action is supported by a responsible body of medical opinion and is logical, he is not guilty of negligence.

• The modified Montgomery Test - where the doctor must give the patient material information to make informed decisions about tests for diagnosis and definitive treatment - is the reason for increased healthcare cost and defensive medicine, as excessive tests or treatments may be recommended and should be curtailed.

I wish to fulfil my dream of being a good doctor. Please help me.

Huang Shoou Chyuan (Dr)