The Singapore Medical Council's disciplinary tribunal's decision to fine an orthopaedic surgeon $100,000 for not telling his patient of possible side effects has caused much uproar and distress in the medical community (Doc fined $100k for not warning patient of injection side effects; Jan 22).
Traditionally, doctors were told by legal experts that we ought to inform patients of complications that are serious, such as death or a serious disability, or common, such as bloating after a gastroscopy examination.
But if every possible complication of a medication or procedure has to be explained to patients, it will be extremely difficult to practise medicine.
As a simple example, the major and common side effects of paracetamol are mainly drug allergy and liver toxicity, if taken in large quantities. But paracetamol is also associated with more than 20 other potential adverse effects, including insomnia and headaches.
If not informing a patient of all potential adverse effects would lead to a $100,000 fine, doctors may simply print out the long list of potential complications and side effects, and give it to patients.
This patient information overload is not necessarily a good thing, as much time would be spent simply digesting that information.
Important points may also get buried within the less key information.
Doctor-patient relationships are based on a foundation of goodwill, that the patient trusts his doctor, and the doctor does his best to help the patient. It will become very difficult for doctors to do their jobs, if they have to cover every possible source of complaints and lawsuits.
Desmond Wai (Dr)