Medical Council reforms a healthy move

One of the ways in which the Singapore Medical Council (SMC) acts as a watchdog of the public interest is through its disciplinary hearings process. This process gives edge to its regulatory function of ensuring that doctors in Singapore live up to the high professional and ethical standards of their calling. The SMC's stringent powers are necessary to prevent doctors from becoming a closed group of professionals who can hold the public to ransom, particularly the individual patient who does not possess the specialised skills to understand, let alone challenge, medical decisions. The council's powers seek to protect the legitimate interests of doctors as well.

However, any system can be improved and a resolve to bring about useful change was clearly evident in the recommendations made by a committee set up to review the handling of disciplinary hearings by the council.

The committee's final report, which comes nearly two years after the High Court criticised the SMC over how it had handled a disciplinary hearing, focuses on several key areas. Speeding up inquiries would help lift some of the mental pressure on doctors facing hearings, while improving legal processes obviously would enhance the value of the disciplinary hearings. Increasing transparency, particularly in the appeals process, would deepen the credibility and acceptability of the disciplinary scheme to doctors. The SMC has said that it is in broad agreement with the recommendations of the committee.

Even as doctors stand to benefit from the SMC improving its processes, one issue important to the public is the charging of medical fees. Guidelines would help patients take informed decisions on seeing specialists in particular. What price premium would be appropriate for expertise and experience? And how would one determine who is top in a field? A system that provides hard data with which to make comparisons would inspire greater public confidence in the financial aspects of the medical system.

It is important, too, for the public to know the ethical limits for fees. An article published in The Singapore Law Review last year drew attention to these issues. It cited a number of doctors calling for the Academy of Medicine, the Singapore Medical Association and the Ministry of Health to come together to "provide answers to the perplexing question of what the ethical limit is". A start has been made by the ministry, which publishes percentiles of bill sizes for each procedure for public and private hospitals. However, as the journal noted, many doctors in private and specialist clinics still face the problem of knowing the ethical limit. Transparency in pricing would help the public to form a judgment about when medical fees can be deemed fair and reasonable.