Improper, excessive issuance of MCs by doctors causes MOH to tighten rules

SINGAPORE: Employers and government agencies have told the Ministry of Health (MOH) that too many medical certificates (MCs) have been issued via teleconsult.

This has caused MOH to consider tightening MC regulations, the ministry said in a joint circular with the Singapore Medical Council (SMC) dated April 22.

The circular reminded doctors of their obligations under the law regarding issuing MCs and is seeking feedback on a proposed requirement for their issuance.

MOH cited feedback regarding the “excessive issuance of MCs following Outpatient Medical Service (OMS) consultations,” which included the MCs being issued without proper clinical assessments and follow-ups but instead were given based on the symptoms reported by the patients.

In other cases, MCs were issued for non-medical reasons. For example, individuals said they wanted an MC that would allow them to be absent from school or work despite not being sick.

The circular also mentioned that MCs have been issued for malingering and abusing medical leave privileges.

“MCs were repeatedly issued to the same patients without referring them for physical consultations for further assessments or follow-ups to check if they were indeed unwell,” it said.

The circular underlined how important it is for MCs to be issued in the context of an existing patient-doctor relationship.

For new patients, real-time, two-way interactive audio-visual communications—i.e., a video consultation—must be used according to Regulation 301 of the Healthcare Services (OMS) Regulations.

“MCs should not be issued via teleconsultations to new patients solely based on the patients’ requests without proper assessment by a medical practitioner to determine if the issuance of the MCs is warranted,” the circular adds.

Another regulation states that if a patient needs an actual physical examination, doctors should advise him or her to seek an in-person consultation with a medical practitioner.

The patient should undergo an actual physical review if an additional assessment is needed before an MC is issued.

The circular notes that one amendment being proposed requires that each MC issued have the name and medical registration number of the issuing doctor.

The medical practitioner should also have provided medical or dental care to the patient, as the case may be.

MOH is seeking feedback on this new requirement under the HCSA. Those who wish to submit their feedback may do so via [email protected] by next Monday (May 20). /TISG

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