SINGAPORE: Doctors do not need to lay out and get the consent of a patient for every side effect or complication of a drug or treatment, Senior Minister of State for Health Lam Pin Min said in Parliament on Monday (Feb 11).
Dr Lam was responding to questions from Members of Parliament (MPs) about the case of orthopaedic surgeon Dr Lim Lian Arn, who was recently given the maximum fine of S$100,000 for failing to obtain informed consent from his patient before giving her an injection.
MPs had asked if if it was now mandatory for a doctor to get the consent of a patient for every possible side effect and complication, and whether this would lead to doctors practising "defensive medicine".
They also asked about the definition of the material information doctors are required to disclose to their patients.
“It is wrong to infer that the decision (of the disciplinary tribunal) makes it mandatory for a doctor to lay out and get the consent of a patient for every possible side effect and potential complications of a drug or treatment,” Dr Lam said.
In the case of the orthopaedic surgeon, it was not that sufficient information was not given, it was that Dr Lim had failed to inform his patient of any side effects at all.
Under the guidelines, doctors are to disclose relevant and material information to their patients, while remote risks with minor consequences will generally be deemed immaterial and need not be disclosed, said Dr Lam.
"What a doctor needs to inform a patient about prior to a treatment or procedure continues to depend on the specific facts of the case, including the particular circumstances of the patient.
"However, what is considered material information was not the issue before the DT (disciplinary tribunal) in Dr Lim’s case, and the DT did not apply the modified Montgomery Test as Dr Lim conceded that he had not informed the patient of any risks or complications at all," said Dr Lam.
The Montgomery Test refers to a legal test to determine whether a doctor was negligent in advising the patient.
MAXIMUM FINE A HARSH PENALTY?
Dr Lam revealed that in determining the sentence, the disciplinary tribunal had considered cases submitted by both counsels involving similar conduct, where the sentences had involved fines from S$5,000 to S$10,000 and suspension orders from three to 12 months.
The maximum penalty for such misconduct had been S$10,000 before it was increased to S$100,000 when the Medical Registration Act was last amended in 2010, he said.
Dr Lam acknowledged that many "fair-minded" doctors would think that the penalty imposed on Dr Lim was harsh.
"There has been considerable concern in the medical profession about the maximum fine having been imposed and that at one point suspension was considered. The concerns are understandable, when considering the facts and circumstances of this case,” he said.
The Sentencing Guidelines Committee appointed on Jan 1 would help in ensuring consistency and fairness in the sentences meted, and improve transparency and rigour in the disciplinary process, he added.
Dr Lam said that the health ministry (MOH) "does not want the (medical) profession to go down the path of defensive medicine", adding that it acknowledged how the profession needs assurance on what the legal position is and what the punishments are when disciplinary proceedings are undertaken.
"We will need to discuss the issues with the profession, in the context of a broader review of the current rules, processes and legal position, to achieve the above outcome," he said.
"My ministry will carefully consider what steps are necessary to maintain the trust between patients, doctors, SMC and MOH," he added.