Complaints against doctors have been creeping up over the past decade – about one in five that the Singapore Medical Council (SMC) finished investigating last year boiled down to poor communication between doctor and patient, says Dr Tan Chi Chiu.
In updating the council’s guidelines on medical ethics, he hopes to reverse the trend – giving patients a better idea of what to expect from treatment by making sure that doctors go through all the important issues with them.
“In the complaints that the Complaints Committee has received, many of them have to do with either poor communication or a misunderstanding of the ethical obligations,” said Dr Tan, a gastroenterologist in private practice who chaired the working committee reviewing the guidelines.
When people complain after procedures go wrong, for example, investigations often throw up a similar issue: Patients felt they were not told enough to make an informed decision.
“Sometimes, what is discovered is that the consent-taking was not a thorough process,” Dr Tan explained. “Information which ought to have been given – regarding the potential for side effects, adverse outcomes, risks and so on – was not clearly explained.”
The SMC received 141 complaints last year – its lowest in six years, although the figure has generally been on an upward trend.
Its updated ethical code and guidelines were announced on Wednesday. This is the first time that these guidelines have been revised since 2002.
Unlike the old set of rules, the new guidelines are more specific on the dos and don’ts. They include detailed advice on issues such as complementary medicine, caring for minors and the appropriate charging of doctors’ fees.
This was intentional, said Dr Tan, as the environment that medical professionals work in is an increasingly complex one.
“We believe that doctors can be better educated and guided on their ethical obligations if guidelines are comprehensive, rather than general and vague,” he said.
The new guidelines also address issues such as fees and appropriate advertising – a necessary addition, said Dr Tan, in an era where medical services have become more commercialised.
Rather than listing the fees which doctors should charge – a measure that was scrapped in 2010 when the Competition Commission of Singapore ruled that doing so was anti-competitive – the guidelines specify the principles doctors should abide by when making commercial decisions.
For example, fees must be “fair and reasonable and commensurate with the work actually done”, while advertising must not “exploit patients’ vulnerabilities, fears or lack of knowledge”.
Cardiologist Kenneth Ng, who is from the Novena Heart Centre, said that the guidelines help doctors to “know where the boundaries are, so that we operate within the allowed confines”.
Meanwhile, general practitioner Yik Keng Yeong said that he makes sure he and his patients are on the same page by explaining the potential effects of treatment.
“For example, if you’re doing a little operation to remove a lump, you’ve got to forewarn the patient that it might cause a scar,” said Dr Yik, who carries out small surgical procedures under local anaesthetic. “You must let them know these things and manage their expectations.”
Added Dr Chua Jun Jin of JJ Chua Rejuvenative Cosmetic and Laser Surgery: “To me as a practising physician, the most important principle that I follow is to do everything we can in the interests of our patients.”
This article was first published on September 18, 2016.
Get a copy of The Straits Times or go to straitstimes.com for more stories.
