Parliament debates on who judges doctors’ conduct in disciplinary cases, patients’ consent before passing laws
On the Singapore Medical Council's panel handling complaints from patients, there are 89 doctors who are not council members and 50 who are not doctors.
- 12 MPs spoke in Parliament on disciplinary processes for doctors
- The amount of information the doctor must disclose to a patient, diversity within the SMC, and doctors’ workload were debated
- WP’s Pritam Singh suggested a review of the new laws governing the processes in two to three years’ time
- Mr Edwin Tong, Second Minister for Law, said regular review is needed given the constant advancements in medical technology
SINGAPORE — When evaluating if a doctor has met the standards of care for a patient, the opinion of a body of medical professionals is important as part of this assessment or test, Dr Koh Poh Koon said.
The Senior Minister of State for Health made this point during a debate on the Civil Law (Amendment) Bill and the Medical Registration (Amendment) Bill before the laws were passed in Parliament on Tuesday (Oct 6).
A total of 12 Members of Parliament (MPs) rose to speak during the debate, raising concerns such as the amount of information the doctor must disclose to a patient, diversity within the Singapore Medical Council (SMC), and whether achieving this new test or standard of care would add to doctors’ workload.
Dr Koh, who is also a colorectal surgeon, said that when giving medical advice to patients, doctors sometimes have to make difficult decisions and take on some professional risks, in order to urge a patient to agree to a life-saving procedure or treatment.
Having a group of medical professionals to examine if the doctor acted reasonably when disciplinary procedures take place is thus vital. Before the changes to the law, it was a court of law that decided on this.
With the changes, the conduct of a medical professional in giving advice to a patient will be judged in accordance to a new statutory “test”.
This new test or evaluation takes into account patient empowerment while providing doctors certainty and confidence when dispensing advice without fear of being sued or worrying if a patient will make a complaint.
Broadly speaking, doctors will need to fulfil certain criteria to meet this standard.
One of these is that their conduct must be deemed to be reasonable professional practice by a group of their peers.
Another is that they must provide information that a patient would reasonably need or ask, so that the patient may make an informed decision. If not, there must be reasonable justification if certain information is not given to the patient.
Dr Koh said that there could be a case of an older patient who may refuse a life-saving surgery due to fear or denial of his or her medical condition.
In such circumstances, the doctor may choose to withhold information from the patient, and instead explain why the procedure is necessary to the patient’s family members.
The changes to the law is to help improve the disciplinary proceedings conducted by SMC, as well as to review the applicable standards when taking informed consent from patients — an issue that came under the spotlight last year due to various high-profile disciplinary cases involving medical professionals.
TAKING NOTE OF PATIENTS' RECORDS
Responding to the concerns raised by the various MPs, Second Minister for Law Edwin Tong — who opened the debate on the proposed changes — agreed with Dr Koh that doctors sometimes have to “exercise some degree of therapeutic privilege” when making the best decision for their patients.
Therapeutic privilege refers to the withholding of relevant health information from the patient if non-disclosure is believed to be in the patients’ best interest.
That is why, he said, the new statutory test has not been deliberately labelled as either doctor- or patient-centric. Instead, it is a “common denominator of benefiting the patient and the doctor together”, he added.
Dr Lim Wee Kiak, MP for Sembawang Group Representation Constituency (GRC) , asked how far back into a patient’s medical records would a doctor reasonably need to peruse when giving medical advice to patients.
Mr Tong replied that it would not be reasonable for doctors to look at all available records.
However, he also said that it would not be possible for the Government to “come up with a formula” on what is reasonable information for the doctor to consider since it is “very situational, fact specific and fact dependent”.
DOCTORS’ WORKLOAD
Mr Pritam Singh, the Leader of the Opposition, questioned if doctors will have enough time to adequately go through the consent-taking process with patients, since the new standards could add to doctors’ workload.
This is especially for doctors in a polyclinic or general practitioner setting, who have many patients to see and short consultation times, the Workers’ Party (WP) MP for Aljunied GRC added.
To this, Mr Tong said that he sympathised with doctors on the potential increase in workload, but emphasised that the focus of the test should be on what is good for the doctor-patient relationship.
That being said, he disclosed that cases seen at polyclinics have been on the decline compared with 10 to 15 years ago.
SMC'S COMPLAINTS PANEL
Several MPs asked about the composition of the panel in SMC handling complaints and if there may be a lack of manpower.
Nee Soon GRC MP Louis Ng, for instance, said that the lifting of the limitation for non-SMC members to sit on the complaints panel may not be enough.
Aljunied GRC MP Leon Perera from WP also asked if patient advocate representatives can play a role in the disciplinary processes so that the outcomes of decisions may better balance the interests of all stakeholders.
Mr Tong replied that on the complaints panel, there are 89 doctors who are not SMC members and 50 who are not doctors.
Of the 50, 18 are legal professionals and another 32 are laypersons.
“Looking at these numbers, the representation by non-doctors is not small and not insignificant,” Mr Tong said, adding that SMC takes into account the input of this group in setting up its committees.
Mr Singh suggested that the Government review the new laws in two to three years to see if the new disciplinary process has worked in practice.
Agreeing, Mr Tong said that this is the “baseline consideration given that medical technology innovation is changing”.
“And we do want to ensure that our system… is constantly updated and kept with the progress,” he said.
