Dr Yik Keng Yeong pointed out that doctors may be in a respected profession, but are not immune to the same weaknesses and impropriety that afflict their contemporaries from time to time ("Ethical scrutiny applies to all professions"; Forum Online, Aug 24).

In spite of patients being more knowledgeable, with the free flow of information and correspondingly higher expectations, they are never in full knowledge of everything when interacting with their doctors.

Most patients will not question or challenge their doctor when laboratory and radiology tests are recommended. Tests ordered and medicine prescribed may be more than necessary.

Perhaps the most common complaint against medical practitioners is that of perceived overcharging. Often, a patient gripes about the bill when it is far from what he expects.

Doctors must inform patients what to expect at different stages of treatment, from the cost of diagnostics and procedures to the cost of a hospital stay.

If there are additional charges owing to complications, the patient and his family must be updated at the earliest opportune time.

When an estimate of the total bill is satisfactorily communicated from the outset, and agreed upon by the patient, complaints of overcharging may not arise in the first place.

The Singapore Medical Association fee guidelines were abandoned after the Competition Commission of Singapore ruled that they were anti-competitive in nature.

Even though these guidelines no longer exist, their fee range should be used as a point of reference, with inflation taken into account.

The Ministry of Health is leaning towards greater price transparency through the publication of percentiles of bill sizes for straightforward procedures in both restructured and private hospitals.

However, owing to the great disparity in professional fees among surgeons in private practice, we are far from agreeing on what is fair.

The Hippocratic Oath makes it clear that doctors have a higher ethical obligation, which must prevail over all other business considerations.

So long as the ethical limit for doctors' fees remains discretionary, a reintroduction of fee guidelines is long overdue.

Edmund Khoo Kim Hock