In more than 35 years as a doctor in Singapore, I have never felt more despondent as now and I am certainly not alone in losing confidence in how self-regulation is administered by the Singapore Medical Council (SMC).
Three recent SMC cases have shocked doctors:
•A 2017 case when paediatrician Chia Foong Lian was suspended for three months for missing a difficult diagnosis;
•A case this year when orthopaedic surgeon Lim Lian Arn was fined $100,000 for failing to tell his patient that a steroid injection could have side-effects such as discolouration of the skin; and
•A breach of confidentiality case this year, when psychiatrist Soo Shuenn Chiang was fined $50,000 for writing a memo to get a patient admitted to the Institute of Mental Health.
What followed were unprecedented petition drives by the hitherto conservative medical professionals, who signed three petitions consisting of 1,000, 6,400 and 8,400 signatures in the three cases respectively.
The doctors I know who signed the petitions are serious-minded people who do not put ink to paper lightly as their professional reputations are at stake.
The Ministry of Health formed a work group last month to review the taking of informed consent and the SMC disciplinary process.
How do I want medicine to be practised in Singapore?
•In good faith, I will use all my skills and knowledge to help every patient. Many diagnoses may initially remain elusive, but this is not necessarily negligence.
•Many treatments and medications have known complications that are often unavoidable. I may not have the time to explain every one of these complications, nor do I feel that I have to.
•Patients are often treated as part of a family unit and I have always shared relevant knowledge with their loved ones for them to make collective decisions.
•Our courts have reiterated that the Bolam-Bolitho test is relevant in measuring a doctor's action during diagnosis and treatment. Briefly, this test says that if the doctor's action is supported by a responsible body of medical opinion and is logical, he is not guilty of negligence.
•The modified Montgomery Test - where the doctor must give the patient material information to make informed decisions about tests for diagnosis and definitive treatment - is the reason for increased healthcare cost and defensive medicine, as excessive tests or treatments may be recommended and should be curtailed.
I wish to fulfil my dream of being a good doctor. Please help me.
Huang Shoou Chyuan (Dr)