Medical council's ruling too harsh

The Singapore Medical Council's latest action against an orthopaedic doctor in private practice is punitive and detrimental to the medical profession (Doc fined $100k for not warning patient of injection side effects; Jan 22).

Steroid injections are the most cost-effective first-line treatment for many musculoskeletal inflammatory or repetitive strain problems.

These are routinely given daily by even the most junior trainees in orthopaedic and hand surgery. Significant adverse effects or complications are exceedingly rare.

Minor side effects are more common but still rare, resolve on their own, and are of no lasting consequence to the patient.

I cannot recall any senior surgeon routinely going through these minor side effects with every patient at any of the centres I have worked at throughout my training in Singapore, Australia and the UK.

It is, therefore, very disturbing that a senior orthopaedic surgeon has been fined $100,000 and that the SMC's legal counsel even sought a five-month suspension for his failing to inform the patient of them.

This is too punitive and certainly not commensurate with the severity of the offence, which until now, was not even considered wrong by the vast majority of doctors doing this procedure.

This ruling has grave implications on how medicine is practised. If patients need to be informed of even the most minor side effects of treatment, then the cost and time of treatment must necessarily increase.


Every procedure has potential complications. Every drug prescribed has a long list of potential minor side effects.

Nurses would have to go through the list of all possible complications from taking blood samples, inserting an intravenous cannula, or administering an intramuscular injection.

None of these procedures is currently done with an informed consent as detailed as the SMC's latest judgment requires, and for good reason. To do so would paralyse a busy accident and emergency unit, ward or clinic.

I urge the medical council to seriously consider the wider implications in passing its judgments. In setting impractical standards and adopting punitive sentencing for minor offences, even good doctors will fall foul, because every doctor makes honest mistakes.

This deters not just wrongdoing, but also people from entering the medical profession altogether, to society's detriment.

Andrew Yam Kean Tuck (Dr)

A version of this article appeared in the print edition of The Straits Times on January 26, 2019, with the headline 'Medical council's ruling too harsh'. Subscribe