SINGAPORE: The Ministry of Health (MOH) intends to issue legally binding clinical practice guidance in specific areas, Health Minister Gan Kim Yong announced in Parliament on Monday (Apr 1) as part of his statement on protecting patients' interests and supporting the medical community.
On the issue of informed consent, which came to the forefront recently after a doctor was fined S$100,000 for failing to take informed consent for a procedure, the guidance would explain what nature of information would be considered to be "relevant and material" to patients.
Informed consent is the process by which doctors provide patients with relevant and material information about the recommended course of treatment, the potential risks of the treatment and possible alternatives, so as to enable the patient to make an informed decision with regard to their care options.
MOH will engage the medical community and public before issuing the guidance, Mr Gan said.
Mr Gan added that feedback from the medical profession was that doctors are not sure how to apply the new legal test for informed consent, instituted in 2017, in practice settings.
"There is uncertainty and concern among doctors as to exactly what information would be considered to be relevant and material from the patient’s perspective, and when and how consent needs to be taken," Mr Gan said.
EVIDENCE OF DEFENSIVE MEDICINE BEING PRACTISED
In the current climate of uncertainty, there is a "real risk" that medical practitioners will adopt defensive practices, Mr Gan noted, adding that there was evidence of it already happening.
"Fearing that they might be called out should a complication occur, doctors are likely to overwhelm patients with voluminous information on multiple unlikely risks, protecting themselves legally but confusing patients," he said.
He added that this would be "highly detrimental" to Singapore’s healthcare system and will damage the trust between doctors and their patients.
"We should guard against turning into the kind of society where doctors care more about not being sued or disciplined by the professional body than about the patients’ well-being," the minister said.
He pointed to the United States as a “prime example” of a healthcare system where large sums were awarded for medical negligence, with a significant fraction of healthcare costs going towards medical indemnity insurance, and that patients and society as a whole would end up bearing these costs.
"We aim to give healthcare professionals more certainty on aligning their practices with the rest of the healthcare community and discharging their ethical and legal obligations to their patients," he said.
HANDLING REQUESTS FOR ASSISTANCE FROM PATIENTS’ NEXT-OF-KIN
Beyond the issue of informed consent, guidance can also be issued on how healthcare institutions and professionals should handle requests for assistance from patients' next-of-kin (NOK) and how to verify the identities of the NOK, Mr Gan said.
"The approach will be balanced, protecting patients' interests and welfare, yet being fair to doctors. There should also be consideration for practical issues such as what to do in emergency situations," Mr Gan said.
He was responding to chairman of the Government Parliamentary Committee for Health Dr Chia Shi-Lu and MP Dr Lim Wee Kiak.
They had asked about a case where a doctor was tricked into providing information on a patient to her brother, which allegedly breached medical confidentiality.
In 2015, director of Neuroscience Clinic at the National University Hospital (NUH) Dr Soo Shuenn Chiang had passed on a memo containing the patient’s medical information to her brother. The brother had posed as the patient's husband in a call to the hospital.
Under Dr Soo's instruction, the hospital staff passed on the memo to her brother, who then used the information to obtain a personal protection order from the patient.
The patient later filed a complaint with the Singapore Medical Council (SMC). The disciplinary tribunal found that the disclosure had caused the patient much distress and fined Dr Soo S$50,000 and he was ordered to pay for the court proceedings.
WORKGROUP’S RECOMMENDATION EXPECTED BY END OF THIS YEAR
MOH had earlier announced that it will review the taking of informed consent by doctors as well as the SMC's disciplinary process.
Mr Gan outlined some of the main problems which have arisen in the operation of the current system, which the review will seek to fix.
These problems include “serious delays” in the disciplinary process and engaging doctors to serve on the Complaints and Disciplinary Committees or as experts.
There is also a wide variance in interpreting standards of care as prescribed in the SMC’s guidelines and the issue of consistency and fairness of sentences meted out.
The recommendations of a workgroup, which comprises of doctors, legal professionals and people with relevant expertise, are expected by the end of the year, the minister said.
A series of engagement sessions have been planned, Mr Gan added. The first few town-halls were conducted with SingHealth and Gleneagles last week.
The workgroup, which will completely review the SMC’s complaints and disciplinary processes, is led by medical director of the National Neuroscience Institute, Associate Professor Ng Wai Hoe, together with Ms Kuah Boon Theng, a lawyer who specialises in medico-legal cases.
The workgroup will also review and study the legal and practical applications of taking informed consent, Mr Gan said, adding that members will evaluate the practice in different settings, as well as study the practices in other jurisdictions.
"It will make recommendations to the Government on every aspect of informed consent, and give guidance to the medical profession on the what, where and how in taking informed consent," he said.
"The intent is to provide the medical community with clear practical guidelines so that doctors do not have to second guess what is needed in each case."