1 in 5 complaints against docs due to poor communication

Patients felt they were not told enough to make an informed decision.
Patients felt they were not told enough to make an informed decision. PHOTO: ST FILE

SMC's new guidelines aim to give patients better idea of what to expect from treatment

Complaints against doctors have been creeping up over the past decade - about one in five that the Singapore Medical Council (SMC) finished investigating last year boiled down to poor communication between doctor and patient, says Dr Tan Chi Chiu.

In updating the council's guidelines on medical ethics, he hopes to reverse the trend - giving patients a better idea of what to expect from treatment by making sure that doctors go through all the important issues with them.

"In the complaints that the Complaints Committee has received, many of them have to do with either poor communication or a misunderstanding of the ethical obligations," said Dr Tan, a gastroenterologist in private practice who chaired the working committee reviewing the guidelines.

When people complain after procedures go wrong, for example, investigations often throw up a similar issue: Patients felt they were not told enough to make an informed decision.

"Sometimes, what is discovered is that the consent-taking was not a thorough process," Dr Tan explained. "Information which ought to have been given - regarding the potential for side effects, adverse outcomes, risks and so on - was not clearly explained."

  • Updated guide for doctors

  • What's new in the Singapore Medical Council's (SMC) updated ethical guidelines for doctors:

    •Sections on telemedicine and end-of-life care, which have become more prominent in recent years. Doctors practising telemedicine, for instance, are reminded that they must try to provide the same quality of care as they would in person.

    •A section on complementary and alternative medicine. Doctors must practise only the forms that are approved by the SMC, and must not mislead patients as to the appropriateness and expected benefits.

    •An expanded section on caring for vulnerable patients who may not be able to make informed decisions, such as minors and people with diminished mental capacities.

    •More specific instructions on how doctors should charge patients, including their ethical obligations to be transparent and charge "reasonable fees" that are commensurate with the work done.

    •Detailed guidelines on the way doctors advertise their services. These include advertising in a way that does not exploit patients' insecurities, fears or lack of knowledge.

    •Guidelines on the appropriate use of social media, such as not initiating social media relationships with patients, and making sure that the things they choose to make public do not bring the medical profession into disrepute.

    Linette Lai

The SMC received 141 complaints last year - its lowest in six years, although the figure has generally been on an upward trend.

Its updated ethical code and guidelines were announced on Wednesday. This is the first time that these guidelines have been revised since 2002.

Unlike the old set of rules, the new guidelines are more specific on the dos and don'ts. They include detailed advice on issues such as complementary medicine, caring for minors and the appropriate charging of doctors' fees.

This was intentional, said Dr Tan, as the environment that medical professionals work in is an increasingly complex one.

"We believe that doctors can be better educated and guided on their ethical obligations if guidelines are comprehensive, rather than general and vague," he said.

The new guidelines also address issues such as fees and appropriate advertising - a necessary addition, said Dr Tan, in an era where medical services have become more commercialised.

Rather than listing the fees which doctors should charge - a measure that was scrapped in 2010 when the Competition Commission of Singapore ruled that doing so was anti-competitive - the guidelines specify the principles doctors should abide by when making commercial decisions.

For example, fees must be "fair and reasonable and commensurate with the work actually done", while advertising must not "exploit patients' vulnerabilities, fears or lack of knowledge".

Cardiologist Kenneth Ng, who is from the Novena Heart Centre, said that the guidelines help doctors to "know where the boundaries are, so that we operate within the allowed confines".

Meanwhile, general practitioner Yik Keng Yeong said that he makes sure he and his patients are on the same page by explaining the potential effects of treatment.

"For example, if you're doing a little operation to remove a lump, you've got to forewarn the patient that it might cause a scar," said Dr Yik, who carries out small surgical procedures under local anaesthetic. "You must let them know these things and manage their expectations."

Added Dr Chua Jun Jin of JJ Chua Rejuvenative Cosmetic and Laser Surgery: "To me as a practising physician, the most important principle that I follow is to do everything we can in the interests of our patients."

A version of this article appeared in the print edition of The Sunday Times on September 18, 2016, with the headline '1 in 5 complaints against docs due to poor communication'. Print Edition | Subscribe