MOH accepts proposed 'informed consent' guidelines on what doctors need to tell patients for treatments

neither doctor should have been found guilty, according to the Court of Three Judges.
neither doctor should have been found guilty, according to the Court of Three Judges.PHOTO: UNSPLASH

SINGAPORE - Serious concerns for doctors, including how they treat patients and how complaints against them are dealt with, could be allayed with changes suggested by a work group tasked with identifying and correcting problems facing the medical profession.

These include how much information they need to tell patients in order not to be hauled up for wrongdoing, and also the delays of up to six years that they have to face in resolving the complaints made against them.

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 work group set up by the Ministry of Health (MOH) in March has submitted a total of 29 recommendations which have been accepted by the ministry.

Some of the changes will require amendments to the law, Senior Minister of State for Health Edwin Tong told reporters on Tuesday (Dec 3) following a press conference by the work group, adding that these will be in place by the first half of next year.

Senior Counsel Kuah Boon Theng, who co-chaired the work group, said at the press conference held at the ministry that it was given a "blank canvas" to find issues on the ground, 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 popped up time and again was doctors saying they were moving towards defensive medicine - in other words, they were more concerned about not getting sued than what was in a patient's best interest.

This arose from a case earlier this year when a doctor was fined $100,000 for not telling a patient about side effects of an injection. Some doctors say they have stopped offering the common injection, have raised the price for it, or overload patients with complete lists of side effects for every treatment.


Ms Kuah said the result is that patients were not better informed and may end up fearful or anxious.

The work group's Report on Recommendations 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".

The work group wants guidelines on what doctors need to tell patients for common treatments. These will largely be the common side effects, as well as less common but serious ones.

Based on a patient's profile, doctors may want to provide more information. They must also answer any questions from patients. Ms Kuah added that doctors also must not be "selective and steer patients to a particular treatment".

The other recommendations addressed the long delays when complaints are made against doctors.

There have been several cases where a doctor's penalty had been halved because of the many years taken to resolve a case. There were even cases that were stopped because the doctor had died before they were resolved.

It wants complaints to be dealt with within 18 months.

Doctors worry that the Singapore Medical Council acts as investigator, prosecutor and judge, casting doubts on the independence of such inquiry. Faith in the system has eroded, the report said.

The work group suggested setting up a separate body called a Disciplinary Commission - funded and appointed by MOH, with its own secretariat - to deal with disciplinary hearings, the way it is done in Britain.

It also wants a High Court Judge or a Judicial Commissioner to chair the proposed commission's hearings of complex cases. The other two members of any disciplinary tribunal set up by the commission to hear cases will be doctors, to retain self-regulation by the medical profession. 

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


To speed up dealing with complaints - an average of 165 complaints are made each year - a new Inquiry Committee to be set up under the SMC will filter out frivolous or vexatious complaints.

Mediation may be recommended in some cases.

Existing blocks, such as a legislated cap of only 100 doctors who may be called to serve on a Complaints Committee, will be scrapped.

It also wants more resources pumped in to address the backlog of 223 complaints and 40 disciplinary hearings. It said the situation is "untenable" and wants these cleared in the next two and a half years.

There will be a "dual track" to deal with complaints - one track to deal with new complaints under the new system, and the other to clear the backlog.