When having too much information does not help

Since May, the Singapore Court of Appeal has adopted a new legal test, the modified Montgomery test, to determine if a doctor is negligent (Court adopts new legal test to determine if doctor was negligent; May 13).

Essentially, it requires doctors to empower patients to exercise their autonomy by giving them information they need in order to make meaningful decisions about their own care.

And doctors are expected to tailor the depth of medical information according to the patients' social and educational backgrounds.

I recently had an elderly patient with advanced liver cancer and liver cirrhosis. In my medical opinion, best supportive care would be the treatment of choice for him.

But when the family heard about other options like immunotherapy and liver dialysis, they requested these treatments.

The family wanted to exhaust all means, and try any treatment that could have potential benefits, before agreeing to palliative treatment.

Immunotherapy and liver dialysis are expensive, associated with high risks, and have had no proven benefit in patients with concurrent advanced liver cancer and cirrhosis.

My oncologist colleague and I had to spend much time and effort to explain to the family why such treatment was not cost-effective and potentially harmful to the patient.

While the Montgomery test gives autonomy to patients, it requires doctors to explain the pros and cons of all options.

Giving all options to patients, though unsuitable and potentially harmful, from the doctors' point of view, could actually create more confusion for the family.

Some patients and families may have unrealistic expectations, and request unsuitable treatment to be administered.

Perhaps all stakeholders should reconsider if the Montgomery test is the ideal standard for our healthcare.

Desmond Wai (Dr)

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