Certain cases of professional misconduct are grossly wrong, such as the selling of sleeping pills or cough mixtures to the public purely for profit, and most would agree that punishment for the doctors involved should be harsh.

But cases involving professional misjudgment often stir up much discussion (Doctors need guidelines for tribunal penalties; Oct 3).

Take, for instance, the case of a patient who presents with abdominal pain.

The pain could be caused by a diverse range of possibilities.

Some doctors may opt to do a blanket of tests upfront, such as a CT scan to check for acute appendicitis.

This approach clinches the diagnosis rapidly but would cost a lot and require a lot of resources, such as CT scan machines, radiologists and radiographers, to be available round the clock.

Another approach is to do investigations in a step-wise manner, that is, to do a limited set of tests first and proceed to more advanced tests, including a CT scan, only if no cause is found or if the clinical suspicion of acute appendicitis is high.

This approach is more logical and cost effective, but would inevitably lead to delays in diagnosis in some patients.

Choosing which approach to take is a professional judgment call of doctors, and there is no absolutely right or wrong way.

Penalising doctors severely for professional misjudgment may lead to the unintended consequences of over-investigation and the practice of defensive medicine.

It is high time all stakeholders - patients, the public, medical personnel, administrators and the Ministry of Health - pay special attention to this type of professional misconduct and adjust the penalties accordingly.

Desmond Wai (Dr)