Singapore Medical Council: Doctors not expected to inform patients of all possible complications

Doctors are not expected to inform patients of all possible complications, the Singapore Medical Council (SMC) said yesterday following concerns raised last week after a private orthopaedic doctor was fined $100,000 for not telling his patient about possible side effects from a commonly used injection he gave her.

The council also said the decision by the disciplinary tribunal did not mean that doctors must take written consent for every minor treatment or procedure.

"The decision merely reminds doctors that they should document the fact that they have explained the treatment or procedure and the patient's consent," said the SMC in the statement.

The doctor who was fined, Dr Lim Lian Arn, had given his patient a H&L steroid injection for pain in her left wrist. He did not tell her of the possible side effects of the injection but had not actively recommended the treatment.

The injection can cause a patient to experience increased pain and inflammation in the area injected, which can be worse than the pain and inflammation caused by the condition being treated. The pain typically lasts for one to two days.

More than 4,000 people, mostly doctors, later signed a petition to Health Minister Gan Kim Yong following the ruling, concerned that the ruling could change the way medicine is practised here by imposing a significant additional burden on doctors.

SMC yesterday said the court clarified that an "information dump" would not be appropriate, and that "a reasonable patient would not need or want to know and understand every iota of information before deciding whether to undergo a proposed treatment".


The disciplinary tribunal appreciated that it was "in fact not common" to take specific written consent for a H&L injection, and is not mandating such a practice. However, the tribunal said that it would be good clinical practice to document in the case notes that a patient had been informed and was agreeable to the injection - "a proposition which no doctor would reasonably disagree with", said SMC.

Dr Lim had admitted that he had not advised the patient of any possible complications, said SMC.

"He explained that this case was an isolated incident and wholly uncharacteristic of his usual clinical practice, as he could normally outline all treatment options to his patients, including the possible complications of the treatment," it said.

"It should be emphasised that Dr Lim was charged for wholly failing to inform the patient of any possible complications and not for failing to inform the patient of all possible complications that could arise from the H&L injection."

Dr Tho Kam San, who started the petition, told The Straits Times that he respects the SMC's decision and was glad to note that doctors would not face the expectation to inform their patients of every possible complication.

"We would like to thank Minister Gan Kim Yong and SMC for clarifying the position on this issue. We all strive to develop the best healthcare in Singapore to cater for the needs of all Singaporeans."

A version of this article appeared in the print edition of The Straits Times on January 31, 2019, with the headline 'SMC: Doctors not expected to inform patients of all possible complications'. Subscribe