SINGAPORE - The recent case of a doctor who was fined $100,000 for not telling his patient of the side effects of a common injection does not mean doctors have to list every possible side effect or complication of a drug or treatment, said Senior Minister of State for Health Lam Pin Min.

Four MPs had asked about the impact of the Singapore Medical Council's (SMC) disciplinary tribunal's decision, which had sparked concerns among many doctors here that it would lead to more defensive practices henceforth.

Responding on Monday (Feb 11), Dr Lam said: "It is wrong to infer that the decision makes it mandatory for a doctor to lay out and get the consent of a patient for every possible side effect and potential complications of a drug or treatment."

The SMC had fined Dr Lim Lian Arn, an orthopaedic surgeon in private practice, $100,000 after he pleaded guilty to a charge of professional misconduct for not telling his patient the possible side effects of a commonly given steroid injection.

Doctors had sent a petition to the Ministry of Health on the matter. Doctors generally do not tell patients about side effects which are both transient and fairly rare, as with this injection.

Speaking in Parliament, Dr Lam noted that Dr Lim had admitted he was guilty of failing to inform the patient of any risks and complications that could arise from the injection.

"He was not found guilty for failing to inform the patient of all possible complications," the Senior Minister of State added.

Dr Lam acknowledged that "there can be questions as to whether this ($100,000) was too high a fine, and why the SMC was asking for a five month suspension".

The doctors' concerns are understandable, he said, "when considering the facts and circumstances of this case".

He added: "Many fair-minded doctors would think that the penalty imposed was harsh."

Last month, the SMC set up of a Sentencing Guidelines Committee which will "help in ensuring consistency and fairness in the sentences meted, and improve transparency and rigour in the disciplinary process", said Dr Lam.

He pointed out that the medical disciplinary process is self-regulated, and that the Complaints Committees (CCs) and the Disciplinary Tribunals (DTs) make their decisions independent of the SMC.

In the last six years, the CCs had looked into more than 900 complaints and sent 8 per cent of these to DTs, with the profession accepting most of the sentences. Only in a few cases were questions raised, he said.

But as the ministry does not want to see the practice of defensive medicine here, it will "discuss the issues" with the profession.

Said Dr Lam: "We acknowledge that the profession needs assurance on what the legal position is, and what the procedures/punishments are when disciplinary proceedings are undertaken."

Non-Constituency MP Daniel Goh asked what would happen in the event that a doctor does not inform a patient about one side effect on a list of possible complications, and that particular side effect ends up affecting the patient.

Replying, Dr Lam reiterated that there is no need for doctors to list all side effects.

"What's important is that the doctor needs to inform the patient of complications or side effects that are relevant to the patient," he said.

Dr Lim Wee Kiak (Sembawang GRC) said that while the medical profession is self-regulated, the Health Ministry should nevertheless have oversight.

In this case, the $100,000 fine "is excessive", he said, asking if the ministry would consider re-opening this case.

There is no need to do so, said Dr Lam, as both parties had accepted the judgment.