Faster processing of complaints against doctors will mean swifter justice for the patients and doctors involved, and clearer guidelines will let doctors place patients first, if a work group's recommendations to improve the Singapore Medical Council's (SMC) disciplinary process are accepted.
Announcing the interim measures at a medical congress yesterday, Senior Minister of State for Health Edwin Tong said: "As a patient, we must be able to trust that our doctor is doing his best for us, whether in making a diagnosis or in advising on the differential options for treatment."
Doctors, he noted, should be able to trust that the system they operate in is fair and transparent, rather than resort to defensive medicine, where excessive tests or procedures are done to limit the risk of lawsuits, an approach which also increases costs for patients.
To save time and reduce costs, the work group has suggested that a new Inquiry Committee be set up to filter complaints made to the SMC, which can take years to resolve a case.
It will decide within three weeks if they should be dismissed, referred to the Complaints Committee or whether both parties should go for mediation. The aim is to conclude the cases within within one and a half years.
There is scope for mediation about 80 per cent of the time, 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 is no issue of dishonesty - then those are appropriate."
The work group was set up in March to look at both the disciplinary process and the issue of informed consent, after two judgments by the medical watchdog had doctors here up in arms.
In one case, the council fined a doctor $100,000 for not telling a patient about the side effects of a commonly used steroid jab. In another, a doctor was fined $50,000 for releasing information about a patient without checking that a caller on the phone was her husband.
In the first case, the decision caused an uproar within the medical profession because most doctors who prescribe that jab usually do not tell patients about the side effects, which are both rare and transient. In the second, thousands signed an online petition arguing that the doctor had been trying to help the patient.
Under the revised guidelines, the issue of informed consent and when it is needed will be made clearer.
Currently, the SMC gets about 150 complaints a year, with 10 to 15 dismissed, and a similar number sent to the Disciplinary Tribunal to conduct a disciplinary inquiry.
The rest are handled by the three-person Complaints Committee, which has three months to decide how cases will be handled and is allowed unlimited extensions if needed. Moving forward, it will be allowed only one extension and it will have to apply to the courts for more.
Mr Tong said: "We want to apply resources up front as early as we can because you actually can resolve it pretty quickly. So, the work group is looking at a much tighter timeline for every step of the way."
The Ministry of Health may also set up a disciplinary commission independent of the SMC as an added safeguard.
Mr Tong added that the SMC's Ethical Code and Ethical Guidelines are overly detailed and prescriptive. "The proposal is for (them) to be pared down to several core, irreducible principals that outline the parameters and practice of ethical boundaries."
Said Dr Wong Chiang Yin, a member of the work group and former executive director of cord blood bank Cordlife Group: "I think the SMC's Ethical Code and Ethical Guidelines are too long - it is hard for anybody to remember what is there. There should also be a more expeditious path to look into complaints and dismiss those that are vexatious."