SINGAPORE - Trust between patients, doctors and the professional disciplinary system is essential for Singapore's healthcare system to function effectively.

But these relationships of trust are under "serious threat of erosion" following two high-profile cases brought by the Singapore Medical Council (SMC) against doctors, said a work group appointed by the Ministry of Health (MOH).

In a 99-page report released on Tuesday (Dec 3), the Workgroup to Review the Taking of Informed Consent and SMC Disciplinary Process laid out its recommendations to the Government to restore trust in the system.

It said the system has been under strain for some time, adding that there has been "growing disquiet and pessimism within the medical fraternity", even before the cases were brought.

As an example, the report cited a key legal decision by the Court of Appeal in 2017 that changed the legal test for determining whether a doctor is guilty of medical negligence.

In ruling on a case brought by a businessman against a surgeon, Dr London Lucien Ooi, the Court of Appeal set out a new standard for the taking of informed consent, finding it was no longer sufficient for doctors to simply follow prevailing medical practice standards while disclosing the risks and complications of procedures to patients.

Instead, doctors must now consider what is relevant to their particular patient at that particular point in time.

Although the new legal standard aimed to be nuanced and well balanced in promoting patient autonomy, many doctors perceived that it introduced an element of variability and uncertainty in terms of what each patient might want to know, the work group said.

It added that many doctors expressed confusion and anxiety about what they are now required to do, with some even candidly admitting that they now practise defensively just to be sure.

Against this backdrop, the High Court also faced two cases brought by the SMC within the span of four months that the work group said "should never have been referred to the Disciplinary Tribunal in the first place".

In one case, the SMC's tribunal ruled against Dr Lim Lian Arn, an orthopaedic surgeon, and imposed the maximum $100,000 fine for negligence, which was "manifestly excessive", the report said.

In the other, Dr Soo Shuenn Chiang, a psychiatrist, was fined $50,000 for giving confidential information about a patient to the patient's brother, which the work group said was a "harsh and inexplicable outcome".

"Some doctors feel that the SMC holds them to unrealistically high standards and prosecutes them for minor breaches. There is also a perception that the private law firms the SMC engages are overly focused on obtaining a conviction," the work group said.

"This perception was reinforced by the recent court decisions. These decisions have quite rightly criticised the SMC's prosecution of cases and the untenable positions taken with respect to the charges and proposed penalties."

The work group said trust between doctors and patients is central to the practice of medicine. The quality of that relationship directly impacts the quality and outcome of care, it added.

In turn, doctors must also be able to trust the professional disciplinary system to produce fair and consistent outcomes, the work group said.

If the system does not effectively and consistently enforce the profession's standards, doctors will be faced with uncertainty and unnecessary stress.

The report said this may cause them to feel pressured to adopt practices that they think will best protect them against potential legal liability, even if those practices are less effective in serving the patient's needs.

"Over time, this will erode the trust of the patient, not to mention undermine patient safety," the work group said.

The SMC's poor handling of complains will also undermine the public's trust in the medical profession over time, the work group added.

For these reasons, the work group recommended to the Government a slew of changes to the SMC disciplinary processes.

The recommendations are intended to ensure that the process is made fairer, more consistent and transparent, the work group said.

Other recommendations include reducing the total time taken to complete the disciplinary process and filtering out cases that do not warrant serious disciplinary action at an early stage.

"This will aid the overall objective of upholding the confidence and trust of both the public and the medical profession in the SMC and the disciplinary process," the report said.