Help young doctors by clearing up ambiguity

Several recent letters highlighted the implications of the Singapore Medical Council's (SMC) Disciplinary Tribunal case against Dr Lim Lian Arn.

Dr Lim was fined $100,000 for not informing his patient of the possible side effects of an injection he had given her (Orthopaedic surgeon deserves more lenient punishment, Jan 29; Build trust in relationship between doctors and patients, Feb 1; SMC must consider wider implications of its rulings, Feb 5).

The judgment highlights the difficulty that junior doctors in Singapore face daily at work.

On graduation, junior doctors practise under supervision for about five years in public institutions. During this time, they perform many common procedures daily, including intravenous drug administrations, arterial punctures, and suturing small wounds.

We agree with the general principles of good practice: patients being adequately informed about their medical condition, options for investigations and treatment, consent for all aspects of medical care, surgery risks, among others.

The SMC's recent judgment poses two areas of difficulty.

First, given the number of simple procedures junior ward doctors carry out daily, it becomes impossible for them to fit in the time needed to discuss in full all aspects of all procedures for all patients, and thereafter to formally take and record consent.

Second, junior doctors face this daily conundrum - the differing views among patients, doctors, the institutions they practise at, and even the medical council - on which procedures are minor, which risks are low, and under which situation is consent adequate.The junior doctor will benefit from guidance as to the type of consent needed and extent of the consent to be covered during counselling for each procedure.

Failure to do so will result in a generation of young doctors turning to defensive medicine, which is medically inappropriate and financially more costly for patients and the nation.

We are currently told that the consent required depends on institutional requirements and it is a matter of clinical judgment.

Differing interpretations of what constitutes "acceptable standards" are bound to arise. Clear instructions from the relevant authorities, ideally at a national level, will resolve the current ambiguity, and allow junior doctors to provide appropriate and sustainable healthcare.

Dr Benny Loo

Chairman, Doctors-in-training Committee

Singapore Medical Association

A version of this article appeared in the print edition of The Straits Times on February 11, 2019, with the headline 'Help young doctors by clearing up ambiguity'. Print Edition | Subscribe