SINGAPORE - Faster processing of complaints lodged against doctors through the Singapore Medical Council (SMC) and clearer guidelines and codes for the medical profession could be in place in the coming months.
These are some of the preliminary recommendations from a workgroup formed in March to review the taking of informed consent by doctors and the SMC's disciplinary processes.
Senior Minister of State for Health Edwin Tong announced the proposals at a medical congress on Friday (Sept 13).
The updates come after several high-profile cases of doctors who were perceived to have been unfairly punished, including Dr Lim Lian Arn and Dr Soo Shuenn Chiang.
Mr Tong noted that it is tricky to find the right balance in the doctor-patient relationship, adding that doctors should not practise defensive medicine but instead be able to trust that the system they operate in is fair and transparent.
To this end, he announced the setting up of a new Inquiry Committee that will filter complaints made to the SMC. It will decide within three weeks whether they should be dismissed, referred to the Complaints Committee or that both parties go for mediation, with an aim to conclude the cases within one and a half years.
"We believe that (for) 80 per cent of these cases, there is a lot more scope for mediation, and we want to give the Inquiry Committee a lot more leeway to refer these cases to mediation," said Mr Tong.
"Cases in which there is a misunderstanding over a document, or those that do not result in harm to the patient - if it is not something that fundamentally undermines the integrity of the system and the doctor, and there's no issue of dishonesty - then those are appropriate."
The Health Ministry will work with organisations like the Singapore Mediation Centre to provide expertise.
The SMC receives around 150 complaints each year with 10 to 15 dismissed and a similar number referred to the Disciplinary Tribunal.
Complaints are now handled by a three-person Complaints Committee appointed by the SMC once a grievance has been lodged.
But the council has been criticised for the unnecessary length of time - sometimes years - it takes to deal with these.
The Complaints Committee now has three months to decide how cases will be handled. If it is unable to decide within this timeline, there is no limit to the amount of extensions it can receive from the SMC.
The Complaints Committee will only be allowed one extension; it would then have to apply for more through the courts, said Mr Tong.
He added: "We want to apply resources upfront as early as we can, because you actually can resolve it pretty quickly. So the workgroup is looking at a much tighter timeline for every step of the way."
There will also be a dedicated legal unit to advise both the Inquiry Committee and Complaints Committee on the cases.
The Ministry of Health may also set up a disciplinary commission independent from the SMC and staffed full time and separately resourced.
This commission will include overseeing the Disciplinary Tribunals, training members serving on the tribunals and looking after the co-opting of doctors into its panels.
As an added safeguard, the workgroup also proposes that the SMC review cases that are handled by the Disciplinary Tribunals to ensure that the call is made judiciously, said Mr Tong.
He added that the SMC's Ethical Code and Ethical Guidelines are overly detailed and prescriptive and need to be improved.
"The proposal is for (it) to be pared down to several core, irreducible principles that outline the parameters and practice of ethical boundaries. It will be binding on all doctors," Mr Tong added.
"At the same time, there will be an explanatory handbook that will contain illustrations, guidance notes and so on, that will be developed with the medical community."
Dr Wong Chiang Yin, a member of the workgroup and the former executive director of cord blood bank Cordlife Group, said the interim proposals are a step in the right direction.
"As it stands today, I think the SMC's Ethical Code and Ethical Guidelines are too long - it's hard for anybody to remember what is there," noted Dr Wong, a public health specialist who is now a part-time senior consultant in primary and continuing care division at the Ministry of Health.
"There should also be a more expeditious path to look into complaints and dismiss those that are vexatious."