Patients giving consent should be captured on video

The discrepancy between what the court declares and what the Singapore Medical Council (SMC) says in the judgment against Dr Jen Shek Wei should not be left unclarified.

The SMC asserts that the court found Dr Jen guilty for removing the patient's ovarian mass without informing her (Gynaecologist failed to carry out further evaluations, by Ms Frances Kong; Dec 2), while the court implicitly discloses that consent for the operation was obtained (Court dismisses gynaecologist's appeal against suspension; Nov 16), albeit that the consent was irrelevant when the patient does not fully understand the "nature of the operation".

It does not seem plausible that an educated finance manager, informed to have a possibly cancerous ovarian mass does not know that removal of the diseased area is the offered surgery.

Nor is it likely that a surgeon will remove a woman's reproductive organ without informed consent.

In any case, when consent for surgery is signed, there is also almost always a clause that allows the surgeon leeway to do what is needed to eradicate the disease as the operative situation dictates.

The guideline issued by the the Royal College of Obstetrics and Gynaecology for evaluation of ovarian masses states quite clearly that "a pelvic ultrasound, preferably intravaginally, is the single most effective way of evaluating an ovarian mass".

Doctors need further edification from the court and the SMC what then constitutes further evaluation of ovarian masses, when this investigation is already universally performed when indicated.

While the practice of medicine is full of intricate details that can only be appreciated precisely after years of dedicated study, the succinct details of what needs to be done to eradicate disease and the important relevant complications can be explained and understood by the laity without much difficulty.

But now that the court has ruled a consent form for surgery is "at best an indicator that the obligation has been discharged but is not conclusive as a defence to a charge of failing to take informed consent", the whole practice of medicine needs to be recalibrated.

Videos of relevant surgical operations, together with recorded transcripts of consultations between the doctor and patient may be needed to jolt patients' memories and convince the courts that, indeed, patients were briefed in detail before surgery, lest on party denies the event in a contested suit.

Yik Keng Yeong (Dr)