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Informed consent: Doctors must answer any question patients ask

Informed consent: Doctors must answer any question patients ask

Source: Straits Times
Article Date: 07 Oct 2020
Author: Timothy Goh & Salma Khalik

Law makes clear what doctors should tell patients in bid to cut litigation, defensive medicine.

Parliament passed a law yesterday giving doctors a clearer idea of what they need to tell patients, so that they need not fear litigation or resort to defensive medicine by overloading patients with information or exposing them to more tests than they need.

The move would help prevent poorer care and hold down healthcare costs.

Essentially, the change says doctors need to tell patients only what they "would reasonably require to make an informed decision", said Second Minister for Law Edwin Tong when he earlier presented the Civil Law (Amendment) Bill for debate in the House.

On top of that, doctors have to answer questions patients ask, even if they think it is minor, as what is important varies among patients.

The relationship between patient and doctor is one based on trust, but Mr Tong noted that in recent years, this has been "called into question following several well-publicised medico-legal cases from the Singapore Medical Council (SMC) disciplinary tribunals".

They include the case of Dr Lim Lian Arn, who was found guilty and fined $100,000 for not obtaining informed consent from his patient.

An SMC disciplinary tribunal said he had failed to advise a patient on the risks and possible complications of a steroid injection and some of the side effects subsequently manifested in the patient.

Dr Lim's conviction was overturned, on appeal, by the Court of Three Judges. But the case led to many doctors becoming uncertain about what is required of them when advising patients, and saying they would practise defensive medicine to protect themselves.

Questions also arose on whether the case should have gone to the tribunal in the first place, and the court labelled the conviction a "miscarriage of justice".

"Whenever disciplinary outcomes diverge from well-established practices by doctors on patient care in the medical community, uncertainty follows," Mr Tong noted.

To restore trust between doctor and patient, and the trust of doctors in the medical disciplinary system, another law was amended too - the Medical Registration Act.

This was done through the Medical Registration (Amendment) Bill, which aims to strengthen the medical disciplinary process. Like the Civil Law (Amendment) Bill, it was passed yesterday.

A NEW TEST

The Civil Law (Amendment) Bill sets out the two criteria doctors need to fulfil in giving medical advice to patients.

One, they must act in a logical manner that is accepted by a body of their peers. This is to assure them that their conduct will be assessed by fellow doctors.

Two, they must give information that a patient would reasonably require, or that is material to a patient in making an informed decision.

This means addressing any question asked by the patient.

"The patient can be assured that when he walks into a clinic and sees a doctor, there really are no stupid questions. Every question that this patient raises with this doctor is a valid, relevant question that has to be addressed," said Mr Tong.

For example, the inability to use the little finger might seem minor to a doctor, but could affect the livelihood of a professional pianist.

Even when the patient does not express a concern, if the doctor has access to medical records that show such a concern should have been raised, he must address it.

What is reasonable must be assessed in the context of each case, Mr Tong added.

STRENGTHENING THE DISCIPLINARY PROCESS

The Medical Registration (Amendment) Bill is based on the recommendations of a work group set up in March last year by the Health Ministry to review the SMC's disciplinary process.

It has four main objectives:

  • to improve the quality and consistency of the disciplinary process;
  • to reduce delays;
  • to protect patients better,
  • to encourage mediation.

The passing of the Bill provides for the appointment of a Disciplinary Commission that is independent and separate from the SMC and headed by a senior doctor.

The commission will take over the SMC's role in setting up the disciplinary tribunal. This should address concerns that the tribunals are not independent of the SMC, said Mr Tong.

The tribunals will have a legal professional sitting on it. For complex cases, the commission may ask for a judge or judicial commissioner of the Supreme Court to chair it.

Another change addresses the concern that prosecuting lawyers sometimes go for conviction at all costs, and seek overly severe penalties.

The SMC will now replace the 10 law firms it had used with a Legal Advisory and Prosecution Unit which, over time, should better understand the disciplinary process and appropriate penalties.

Noting the constant feedback of unreasonable delay in the disciplinary process, Mr Tong had pointed to several measures aimed at resolving the issue.

These include notifying the doctor early when a complaint has been made against him, and requiring relevant documents and evidence to be submitted in a timely manner.

Another new move is that the SMC will decide whether a disciplinary hearing is needed, following a Complaints Committee's findings.

Previously, the decision is made by the Complaints Committee.

To protect patients more effectively, investigators now have to report to the SMC if they discover wrongdoing not related to the initial complaint.

The new law also encourages amicable resolution of complaints and facilitates a less adversarial disciplinary process.

The new Medical Registration Act allows an inquiry committee to refer complaints which are not about serious professional misconduct requiring disciplinary action, for mediation.


Essentially, the change says doctors need to tell patients only what they "would reasonably require to make an informed decision", said Second Minister for Law Edwin Tong when he earlier presented the Civil Law (Amendment) Bill for debate in the House.

On top of that, doctors have to answer questions patients ask, even if they think it is minor, as what is important varies among patients.

Source: Straits Times © Singapore Press Holdings Ltd. Permission required for reproduction.

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