I blogged about this topic a few months ago, and a letter to the ST Forum today discusses the results from the feedback exercise:
Medical Act: Did feedback reflect docs' views?
I REFER to last Friday's article, 'Medical Act change: 80% backing for non-doctor to chair discipline panel', which stated that 'nearly eight in 10 people backed this and other changes to disciplinary proceedings and thought it would streamline the process'.
The actual press statement by the Ministry of Health (MOH) last Thursday stated that there were 78 responses received. Of these, 12 were from the public, of which 11 agreed with the proposed amendments under this category. The remaining 66 responses were from 'doctors/health professionals', of which only 18 responses were noted to 'disagree'.
The vast majority of the 8,000 or so doctors in Singapore belong to at least one or more of the following organisations: Academy of Medicine, Singapore (AMS), College of Family Physicians Singapore (CFPS) and Singapore Medical Association (SMA).
All three organisations either expressed reservations or disagreed with the proposed amendment to allow a layman to chair Singapore Medical Council (SMC) disciplinary committees. One can only wonder if the positions of these three large organisations were represented or accounted for adequately in the statistic of almost 80 per cent.
Does the position of one such organisation, which represents anywhere from more than 1,000 to 5,000 members, count as one response and carry the same weight as a response from an individual doctor or an individual member of the public? If so, perhaps the AMS, CFPS and SMA leaderships should organise signature petitions from their thousands of members so MOH can adequately recognise the situation.
MOH should clarify how responses from the AMS, CFPS and SMA representing thousands of doctors were accounted for, so we can better understand how the figure of nearly 80 per cent was obtained.
In addition, I am given to understand that the SMC is a statutory body funded from the annual subscriptions of doctors. If this is so, the least MOH could do is to consider subsidising SMC operations if it really wants a layman to chair SMC disciplinary committees. Not many doctors I know would want to fund a layman to chair such committees.
Dr Adrian Tan Yong Kuan
I share Dr Tan's and indeed the SMA's view that a legal professional may not be sufficiently informed about the complexities of medical cases to be able to make a fair judgement. SMA, I believe, agrued the point very well in its submission the the ministry.
As I have stated before, I see the proposed changes as part of the "democratisation of healthcare" - a belief that laymen (yes, a legal professional or a judge is still a layman when it comes to the field of medicine) have the right and knowledge to understand and make judgements on issues pertaining to a professional field. As a doctor I wouldn't presume to pass judgement on whether a lawyer has conducted the defence of his client with due diligence, or if he had breached the legal profession's code of conduct - why should the reverse be acceptable? Sure, I might comment about it over lunch, but a disciplinary hearing is something that has bearing on a professional's reputation and career, and I believe our lawyers deserve to be judged by someone more qualified than a "tea-room lawyer", just as we deserved to be judged by someone more qualified than a "chambers doctor".
Another undesirable aspect of the "democratisation of healthcare" is exemplified by the feedback to the ministry that a doctor's "communication skills and empathy" were more important than his being on a family practice register (which would indicate that he had undergone training and accreditation in the field of family medicine). The public, not surprisingly, values a "nice" doctor over a competent one; or perhaps (more worryingly) doctors believe that their interpersonal skills can make up for their lack of formal training - are they taking the adage "to comfort always but to heal sometimes" to the extreme?
I see this valuation of empathy over expertise as something that is a threat to family medicine and healthcare in Singapore as a whole as it leads to unhappiness in doctors and their patients due to a mismatch in expectations, and to pressure on GPs to provide non-evidence-based modalities of care based on their "feel-good" factor. Doctors and patients alike need to realise that while a good patient-doctor relationship can lead to better outcomes, it is no substitute for an extensive knowledge base that is required to practise family medicine in this day and age.
The underlying cause of the "democratisation" is probably an erosion in the trust of doctors and the medical establishment as a whole. However, I do not believe that the way to regain this trust is in pandering to the emotional demands of patients, but by changing their expectations of what makes a good medical consultation. As doctors, our duty should be to provide patients with health advice based on the best available evidence at hand, and not to hold their hands and speak comforting words while they die from our outdated and ineffective care.
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9 comments:
I think if we want to make a case that doctors can self regulate, then we need to demonstrate that we can self regulate. My perception of the SMC thus far is that they have been somewhat dismal in their performance. What self regulation have they demonstrated? If all they do is to haul up the most obvious offenders, perhaps a non-medical professional can do at least an equal job if not better.
As far as I can see, the SMC has not provided any kind of professional leadership whatsoever.
It's a very passive institution that is dominated by the MOH anyway, so I don't think it's going to make much difference to our lives one way or the other.
There are actually two issues here.
One regards the 'hauling up' of doctors, and the other regards the 'fairness' of the hearing.
The 'hauling up' has always been open to laymen. Anyone can file a complaint with SMC, so the proposed change does not affect this part.
At the same time, SMC cannot on its own initiative haul doctors up without a complaint. This prevents SMC from becoming a 'police state'.
....therefore.....by the time a lay person lodges a complaint serious enuff for smc to want to act...it is so obvious that you do not require a medical professional to figure out if Dr Quack has been misbehaving.
I disagree (once again).
Take the case of the doctor who told the 12th H1N1 patient that he probably had the seasonal flu. Many laymen think he is at fault. Do you?
That is a an example that is quite irrelevant to the discussion, no? You are comparing a doctor's view with those of relatively uninformed laymen. On the other hand, a poorly informed doctor will not necessarily form a 'better' opinion, just one more sympathetic to the profession.
I could argue that a well apprised non-medical person could probably come up with a more objective opinion.
Do doctors have a monopoly on wisdom?
Not wisdom, but the knowledge of the intricacies of a problem that involves medical conditions, and how it can often be hard to make a decision that seems easy on hindsight.
I think you are probably overstating the case. Most cases dealt with by SMC are pretty straightforward stuff (no magik here...) that will not require the esoteric knowledge of practitioners of the craft.
Those more complex medical jurisprudence cases are best dealt with in a court of law (and presided over by a judge....of all people! :) )
i am not a doctor, but i think the term "medical intracacies" is too often misused as a euphemism for "i missed the most obvious thing". isn't it true that some doctors go round in circles doing all sorts of unnecessary tests on their patients that do not yield much results?
it is incorrect that SMC will entertain laymen complaints and "haul up" doctors who have been "misbehaving". I have tried to lodge a complaint before, and they were pretty much passive, even though there were clear grounds that a particular doctor had overlooked something crucial.
"i think the term "medical intracacies" is too often misused as a euphemism for "i missed the most obvious thing"."
Obvious to whom, and at which point in time?
"isn't it true that some doctors go round in circles doing all sorts of unnecessary tests on their patients that do not yield much results?"
What tests are you referring to?
"there were clear grounds that a particular doctor had overlooked something crucial."
Again, it is not possible for me to comment since you do not mention the specifics.
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