Doctors welcome proposals to improve disciplinary process of the Singapore Medical Council
Doctors are generally upbeat about the proposals such as imposing a stricter timeline on complaint cases and appointing an in-house prosecution unit at the Singapore Medical Council.
SINGAPORE — Doctors have welcomed proposals to improve the disciplinary process of the Singapore Medical Council (SMC), such as shortening the time taken to review cases and setting up an in-house unit to prosecute doctors suspected of errant practices instead of relying on private law firms.
The overview of the preliminary proposals was announced by Senior Minister of State (Health and Law) Edwin Tong on Friday (Sept 13) at a medical conference held at the Carlton Hotel.
While doctors whom TODAY spoke to called the preliminary recommendations “a step in the right direction”, they said that there could be challenges in the implementation of the recommendations if they are eventually approved.
Key among the suggestions by the 12-member workgroup convened in March was the shortening of the time taken to review complaints submitted to the SMC.
This includes the disposal of complaints which end up in the disciplinary tribunal within 18 months, and granting the complaint committee an extension only once.
Currently, the complaint committee evaluates complaints reported to the SMC. If necessary, it will refer the case to the SMC’s disciplinary tribunal, which will summon the doctor to a hearing. While the complaint committee has a timeline of three months, this is frequently extended.
A general practitioner who wanted to be known only as Dr Neo said that shortening the disciplinary process would be good for both patients and doctors.
'FRIVOLOUS' COMPLAINT TOOK OVER TWO YEARS
She recounted an incident where the SMC had taken two and a half years to resolve a “frivolous” complaint made by a patient against her — adding that such a wait could be worse for those who had been accused of more serious complaints.
“I knew that mine was a frivolous complaint but imagine if it had been a real issue. It will just sit in your head for two and a half years and will be difficult for any doctor to go through,” said Dr Neo.
Other recommendations included setting up an in-house prosecution unit at the SMC to handle disciplinary tribunal cases.
Currently, private law firms are engaged by SMC to handle prosecutions, with different lawyers handling the cases each time — resulting in inconsistent outcomes of cases. With an in-house prosecution unit made up of people with prosecutorial experience, prosecutions could be handled quickly, fairly and consistently, said Mr Tong.
While doctors agreed that such a unit could help the SMC save money as well as achieve consistency in the outcome of disciplinary tribunal rulings, they flagged possible challenges in seeking those with specialised knowledge in a medical field to be part of the unit.
Some doctors also raised concerns over the possibility of finding suitable people to be on the proposed new inquiry committee, which would be tasked with filtering out cases that lack substance or are “vexatious” within three weeks.
CHALLENGE TO FIND SUITABLE CANDIDATES
The inquiry committee would help reduce the bottleneck of cases at the complaint committee stage, said Mr Tong.
However, Dr Desmond Wai, a gastroenterologist, said that with the establishment of the new inquiry committee, it may be difficult to find people within the fraternity to serve on it.
He recounted an incident where he had been asked to serve as an expert witness at a hospital inquiry over the death of a liver transplant recipient. Dr Wai said that he had rejected the role as he used to work with the team that conducted the transplant and was concerned that it would raise a conflict of interest.
Dr Wai added that with concerns about conflict of interest, the SMC may have difficulty in finding appropriate people to serve on its committees, including the new inquiry committee.
Mr Tong told reporters on the sidelines of the medical conference that the inquiry committee would be staffed by people experienced with the disciplinary process and who understood the medical and legal processes of the complaint committee and disciplinary tribunal.
He also said that he had received feedback that doctors were still unsure of what to do when it came to the taking of informed consent of patients. Informed consent refers to rules relating to what doctors have to do to get permission to treat patients.
In 2017, the Montgomery test was introduced among practitioners here for the taking of informed consent. The test focuses on the patient’s autonomy and emphasises his or her right to have sufficient information to make an informed decision.
It replaced the Bolam-Bolitho test, which emphasises that the doctor act in accordance with the practices of other medical practitioners in the same field.
Mr Tong had said that many doctors had requested a return to the Bolam-Bolitho test.
Under that test, a doctor is not liable for negligence if he can demonstrate that there is a respectable and responsible body of medical opinion, logically arrived, that accepts the doctor’s practice as proper.
Echoing their sentiments, Dr Andrew Yam, a hand surgeon, said that the test “had served (doctors) well” in the past.
However, Dr Ho Kok Sun, a surgeon, said that a balance was needed between both tests and that patients needed ample opportunities to ask their doctors questions.
Dr Wai added that the Ministry of Health (MOH) could provide more details on what procedures required informed consent, and suggested that the ministry impose a time limit on how long doctors spent taking informed consent from their patients.
The workgroup would continue to consult the medical profession on these preliminary ideas and put forth its final recommendations to the MOH for review at the end of this year, said Mr Tong.
