Forum: New test will enhance doctor-patient relationship

We thank Dr Wang Zhemin and Dr Mona Tan for their feedback (Recent tweaks to Act hinder building of doctor-patient relations, Oct 10; and New policies needed to restore doctor-patient relationship, Oct 13).

The new statutory test for a healthcare professional's duty in giving medical advice is designed to enhance the doctor-patient relationship.

This was also the view of the Workgroup to Review the Taking of Informed Consent and the Singapore Medical Council's Disciplinary Process, which had undertaken a detailed consultation and review in making its recommendation.

The test strikes the right balance in giving doctors more certainty as to the standards to which they would be held. It also prescribes that a patient's queries and concerns ought to be addressed.

Addressing concerns, however, does not mean that every document or entry in the electronic medical record system has to be reviewed each time.

Indeed, we agree with Dr Wang that doctors ought to spend time and attention advising their patients, thereby building the doctor-patient relationship, and avoid being "computer centric".

Dr Wang mentions the practice of medicine in a "fast-evolving climate". It is for that reason that any test for informed consent cannot be overly prescriptive or formulaic in nature. It must take into account factors such as the circumstances of the consultation, the discussion between doctor and patient, and the clinical context when assessing informed consent.

The thrust of the amendments puts the peer professional opinion as the starting point, while taking into account the concerns of the patient.

Doctors can be confident that what is reasonable under the new statutory test will be what is reasonable to their peers, who will be able to appreciate the realities of clinical practice and contextualise the standard to be applied in evaluating a doctor's conduct.

What is reasonable in the age of electronic records will also be shaped by doctors' professional practices going forward.

To this end, and as suggested by Dr Tan, the medical professional bodies will be reviewing existing guidance on the taking of consent, and developing new guidance on information that should be shared for common procedures.

At present, in planning consultation times and appointments, healthcare institutions already factor in the varying time periods required for advising different patients. These will continue to be monitored and adjusted if necessary.

Goh Khean Teik (Dr)

Director, Manpower Standards and Development

Ministry of Health