I agree that guidelines on the penalties imposed by the Singapore Medical Council's (SMC) disciplinary tribunal are overdue (Doctors need guidelines for tribunal penalties; Oct 3).

Having them would ensure greater transparency and consistency in the punishments meted out to errant doctors.

It is important that doctors are held to account for their actions, but a punitive approach doesn't address all the root causes that lead to doctors appearing before the disciplinary tribunal.

Not all disciplinary cases involve misconduct.

Often, there are gaps in the doctor's competence, communication and how care is coordinated. Systemic factors such as the practice setting and lack of collegiality can also contribute to a poor outcome for the patient.

Punitive penalties do little to improve care or to encourage safer medical practice.

In the case of the doctor who delayed in referring his patient to a specialist, a more effective approach would have been to focus on the doctor's clinical decision-making ability.

The SMC should have reviewed the doctor's communication and clinical records over the past few years to ascertain whether there had been other cases of delays in referring his patients to specialists.

The doctor's reasoning and how he explains his clinical decisions to patients should also be considered.

At the end of the day, what patients want is the assurance that any doctor they see is good and that his actions will not harm them.

The onus is on the SMC to ensure that all doctors it registers remain competent and fit to practise. If they are not, then the SMC must take a proactive approach to deal with them.

The SMC owes it to doctors and the public to regulate in a way that is effective, proportionate and rehabilitative.

It is only in this way that doctors learn from their mistakes and make changes that result in better and safer care for their patients.

Charlotte Lowe (Ms)