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Doctors petition against Singapore Medical Council’s decision to impose $100,000 fine on orthopaedic surgeon for not disclosing all possible side effects of treatment

Close to 6,000 signatures have been garnered in a petition against the Singapore Medical Council (SMC)’s decision to fine a private orthopaedic surgeon for not disclosing all possible side effects of an injection given to his patient.

While the SMC tribunal responsible for imposing the fine against Dr Lim Lian Arn did not find any mishaps in the treatment procedure itself, it stressed that the doctor should have given his patient explicit information on the possible side effects of the injection in order to enable her to make an informed decision regarding her own treatment.

Speaking to Straits Times, Dr Tho Kam San, who launched the petition on Thursday (24 Jan), said that the petition does not seek to overturn the ruling, but rather to “clarify issues” that the ruling “has generated”.

While doctors are willing to brief their patients on all of the potential side effects of all treatments should Health Minister Gan Kim Yong instruct them to do so, such an exercise will subsequently reduce the efficiency of doctors’ practices and increase the cost of the treatments overall, as more time will be spent on one patient at a single time, added Dr Tho.

The crux of the petition lies in the fact that the “majority of the medical professionals performing these injections do not routinely take or document a detailed informed consent”.

“For every procedure there are complications that the practitioner, up to now, would have felt were too minor or uncommon to warrant informing the patient.

“Every drug prescribed has a long list of potential side effects. A doctor having to go through each and every one of them would take a very long time, especially with patients on many tablets.

“This ruling has grave implications on how medicine is practised. If patients need to be informed of even the most minor or uncommon side effects of treatment, then the cost and time of treatment must necessarily increase,” stressed the petition.

Kuah Boon Theng of Legal Clinic LLC, a Senior Counsel specialising in medical law and ethics, however told ST that Dr Lim “might potentially have had a viable defence to the charge against him”, as “a doctor is only considered negligent if he failed to disclose information which would be considered relevant and material to the patient”.

“What makes a risk sufficiently material depends on the likelihood and severity of the side effects,” ST reported her as saying, and that in this case, the potential side effects were “limited in nature and extent” according to the SMC tribunal.

“Having said that, contesting the charges means going through a painful and often protracted process,” said Ms Kuah.

Signatories to the petition lay out reasons for signing, citing fears of having to practice “defensive medicine” and turning into an “American-style” litigious society

Many of the signatories to the petition heavily criticised SMC’s ruling, suggesting that the Council’s decision was excessive and counterproductive to medical practice as a whole:

A number of signatories also called upon the Ministry of Health to provide clear, explicit guidelines on what is required of doctors in terms of briefing their patients regarding the potential risks of their treatment, including side effects: