I read with consternation the report on a paediatrician suspended for missing the rare diagnosis of Kawasaki disease (Doctor suspended for improperly treating baby; June 29).

This is something learnt in medical school but which may never be encountered in decades of practice. The incidence in Singapore is 51.4 cases per 100,000 children (0.05 per cent) - almost all aged below 5 years.

The symptoms are non-specific and shared with many other viral fevers in children. There is no definitive test for it.

It is therefore easily missed, especially in the early stages. In the late stage, it may be much easier to diagnose, especially when other conditions have already been excluded.

Everything is easy to diagnose in retrospect.

Even the Singapore Medical Council tribunal acknowledged this, yet insisted on meting out a punitive sentence more appropriate for wilful misconduct.

Because of this, many more specialists are expected to perform every test conceivable to avoid missing a rare diagnosis, so long as there is a 0.05 per cent possibility of it, even if they are 99.95 per cent sure it is a common condition that could be diagnosed without tests.

The extreme defensive medicine prompted by this judgment will increase the already spiralling cost of healthcare.

It is par for the course in the practice of medicine and being human that mistakes will be made.

Being human means we cannot and must not be expected to be perfect. This is impossible and will only lead to unnecessary suffering, both for those who expect it and those it is expected from.

We can only do our best with the knowledge and experience we have, always under the influence of myriad internal and external factors that colour our thinking.

If one constantly and honestly strives to meet a certain standard but fails, such failure should not be punished.

Andrew Yam Kean Tuck (Dr)