Doctors to get guidelines on what to tell patients

The proposals include the creation of guidelines on what doctors need to tell patients for the more common procedures, and having a new committee dismiss frivolous complaints so they need not be dealt with by a Complaints Committee
The proposals include the creation of guidelines on what doctors need to tell patients for the more common procedures, and having a new committee dismiss frivolous complaints so they need not be dealt with by a Complaints CommitteePHOTO: UNSPLASH

Fairer, faster handling of medical complaints also on cards following workgroup's proposals

Doctors will be given guidelines on what they need to tell patients about more common procedures, in recommendations to ensure patients are better able to make informed decisions about their own treatment and doctors are not unfairly penalised for omissions.

A workgroup set up to review informed consent and disciplinary proceedings has recommended that professional bodies and public healthcare institutions come up with the guidelines, which should deal with common side effects, as well as those that are less common but serious.

Other recommendations by the workgroup deal with the long delays faced by doctors in having complaints against them heard.

Its report containing 29 recommendations has been accepted by the Ministry of Health (MOH).

The workgroup was set up in March by the ministry following two high-profile cases in which the doctors were first punished, then exonerated in complaints made against them.

Senior Counsel Kuah Boon Theng, co-chair of the workgroup, said at a press conference at the ministry yesterday that it was given a "blank canvas" to identify issues and correct them, with "patient safety and welfare" the prime consideration.

The group met more than 1,000 doctors as well as patient advocacy groups. An issue that came up time and again was the assertion that doctors were moving towards defensive medicine, which included overloading patients with information to protect the doctor's own interest, rather than the patient's.

The concerns mounted after a case earlier this year in which a doctor was fined $100,000 for not telling a patient about the side effects of a common injection. Some doctors told the workgroup they had stopped offering such steroid injections, raised the price, or were giving patients complete lists of side effects for every treatment.

As a result, Ms Kuah said, patients were not better informed and could end up more fearful or anxious.

 
 
 
 

The report said informed consent is key to a good patient-doctor relationship "because it is only when patients know and understand the treatment they are receiving that their interests are served".

Aside from the guidelines, doctors may provide more information, depending on the patient.

Doctors must also answer any questions from patients, and they must not be "selective and steer patients to a particular treatment", said Ms Kuah.

To expedite justice in complaints made against doctors, the workgroup recommended that complaints be dealt with within 18 months, instead of up to six years.

Some changes will require amendments to the law, Senior Minister of State for Health and Law Edwin Tong told reporters yesterday. These will be in place by the first half of next year.

Another worry raised by doctors is that the Singapore Medical Council (SMC) acts as investigator, prosecutor and judge, which has eroded their faith in the fairness of the system.

The report proposed a separate body funded and appointed by MOH, with its own secretariat, to deal with disciplinary hearings, the way it is done in Britain.

It also recommended that a High Court judge or a judicial commissioner chair the disciplinary hearings of complex cases. The other two members of a disciplinary tribunal should be medical doctors, to preserve self-regulation.

 
 
 

The report said the aim is a "disciplinary system that is independent, expeditious, and which produces fair, consistent and proportionate outcomes".

To speed up the process - an average of 165 complaints are made each year - a new committee to be set up by the SMC will filter out frivolous or vexatious complaints. Mediation may be recommended.

A legislated cap of only 100 doctors who may be called to serve on a complaints committee will be scrapped. The report also wants more resources pumped in to clear the backlog of 223 complaints and 40 disciplinary hearings in the next 2-1/2 years.

A version of this article appeared in the print edition of The Straits Times on December 04, 2019, with the headline 'Doctors to get guidelines on what to tell patients'. Print Edition | Subscribe