A recent controversy within Singapore’s healthcare sector involves the Ministry of Health (MOH)’s request to the Singapore Medical Council (SMC) to review the maximum fine that its disciplinary tribunal imposed on Dr. Lim Lian Arn, an orthopedic surgeon, who was fined S$100,000 for failing to obtain informed consent from a patient before giving her an injection.
The petition was signed by over 4,000 doctors asking the health minister to examine SMC’s decision and shed light on its stand on the necessity of doctors to obtain informed consent for minor procedures like routine injections.
In a statement, MOH believed that the decision could lead to the rampant practice of “defensive medicine” in the country.
To clarify the issue, Senior Minister of State for Health Lam Pin Min stated during a Parliament briefing that there it is not necessary for doctors to sketch out every side effect or complication that a drug or treatment will have to a patient.
When questions regarding Dr Lim’s case were raised by Members of Parliament, Dr Lam said: “It is wrong to infer that the decision (of the disciplinary tribunal) makes it mandatory for a doctor to lay out and get the consent of a patient for every possible side effect and potential complications of a drug or treatment.”
“What a doctor needs to inform a patient about prior to a treatment or procedure continues to depend on the specific facts of the case, including the particular circumstances of the patient,” he added.
Defensive medicine
The issue of defensive medicine is currently in the glare of the public. A term referring to the practice of ordering medical tests, procedures, or consultations of uncertain clinical value so as to shield the physician from malpractice suits.
Classified medical activities under defensive medicine are assurance practices which involve the use of more investigations, more medications and more referrals than would be normally indicated.
These intend to reassure patients and their relatives concerning the quality of care and also offer psychological reassurance for the physicians. On the other hand, avoidance practices involve restriction of practice, including eliminating procedures prone to complications and avoiding patients who have complex medical problems or are perceived as litigious. These practices reflect physicians’ efforts to distance themselves from with a high legal risk.
In short, defensive medicine leads to over-prescription and over-treatment that results in escalating healthcare expenditure.
Senior Minister of State for Health Lam Pin Min himself warned medical doctors against the practice of defensive medicine, saying that this moves away from good clinical practice and would pointlessly swell healthcare spending.
2019 Healthcare budget
A total of $6.1 billion have been set aside under the Merdeka Generation Package, the bulk of which will go towards easing the burden of healthcare costs for practically 500,000 Singaporeans.
According to Finance Minister Heng Swee Keat, “This is a significant commitment by the Government…It is important that the government of the day continues to monitor the patterns and cost of healthcare utilisation, and life expectancy over the next 30 years or more, so that the government is able to meet this commitment,” he said.
While the new provisions of the healthcare budget have been designed to ease the financial burden of Singaporeans – not just the aged but everyone else – will it be enough to meet “healthcare requirements” of those who may be sent to additional but pointless medical tests, procedures, and consultations?
With the imminent hike on goods and services tax, will ordinary Singaporeans be able to reconcile their need for better healthcare service and the rising costs of medical items?
The Merdeka Generation Package, with all its hype and intentions, is expected to strike a balance to these competing scenarios for the benefit of the general population.