Trust is a necessary ingredient of any healthy relationship, whether between friends, spouses or a government and its citizens.

The more trust there is between parties, the less of an explanation will be required.

The selection, training and registration of doctors recognise the importance of trust in the doctor-patient relationship.

They do their best to ensure that doctors have high ethical standards and continue to maintain them but, unfortunately, this cannot be guaranteed.

Society is moving away from a paternalistic doctor-patient relationship to one in which the patient exercises his right to make decisions.

Obviously, this is not possible in an asymmetrical relationship unless the doctor shares information with the patient.

The modified Montgomery test is meant to ensure this, but how effective or achievable is it?

Is a crash course in the patient's condition encompassing every treatment option and potential complication what a sick person really wants or needs?

This is clearly not a case of one-size-fits-all.

A patient may already have had a long relationship built on trust with his doctor, and prefer to leave decisions largely to the doctor.

Others may not easily understand the lengthy and complicated explanations required for their conditions, or have conditions so acute that not enough time is available for a full explanation.

We should work towards a relationship in which the doctor is empathetic enough to give the patient sufficient information to guide him in making decisions, but not so much that the patient becomes overwhelmed.

The patient should also not choose a doctor that he does not trust, and must recognise that trust has to be built up on both sides.

An unimaginative and unempathetic use of the Montgomery test can result in an erosion of the doctor-patient relationship.

It can also result in doctors practising defensive or adversarial medicine.

This is not what society wants, but that is the message being sent by the Singapore Medical Council's (SMC) $100,000 fine.

Surely the SMC can make better use of the Montgomery test to foster good doctor-patient relationships?

Geh Min (Dr)