SMC judgment could stifle spirit of learning among docs
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Following the large fine, doctors could become reluctant to recognise, admit and share their own errors, and thus others will unavoidably repeat these.
PHOTO: ST FILE
It is common that some doctors, as per the summary of Singapore Medical Council's (SMC) Disciplinary Tribunal inquiry, "hold the view that it is not necessary to obtain a patient's informed consent… because such consent would be implied".
Moreover, "the harm occasioned to the patient… was limited in nature and extent". Regardless, the doctor was fined $100,000.
Besides this fine possibly leading to defensive medicine, and thus escalating healthcare costs, I am worried that doctors will quickly become reluctant to recognise, admit and share their own errors, and thus others will unavoidably repeat these.
As a junior doctor working in the former Toa Payoh Hospital and then Singapore General Hospital, I attended the weekly "Mortality and Morbidity Rounds".
Here, doctors would present the cases they had attended to who were difficult to treat, had become seriously ill, or had died.
Some would suggest alternative diagnoses and treatments before the pathologist revealed "the final diagnosis". Everyone present learnt something from every case, and perhaps many similar deaths were prevented.
In some countries (for example, New Zealand) it is a licensing requirement for all doctors to attend discussion groups where they take turns to present cases, especially "near misses", to their peers in a learning discussion.
Would SMC's recent judgment stifle such a spirit of learning in Singapore?
The penalty is no small sum - equivalent to a year's salary among junior doctors. It is now a reference point for determining penalties in similar cases in the future.
Surely many doctors may be forced to turn to defensive medicine for survival, and also to deny any mistake until the last, hoping the accuser would tire and go away.
Would any doctor continue to speak openly and frankly to his patient's relatives, knowing that any misunderstanding would become a complaint to the SMC?
The doctor in this case admitted he had failed to obtain informed consent. Would the tribunal admit that such a hefty fine might be an error that will force doctors to change how they view, and deal with, personally committed professional mistakes?
And would the Ministry of Health or SMC be prepared to help find a way out of this compounding error?
Lee Pheng Soon (Dr)
