Senior Minister of State for Health Lam Pin Min said that doctors do not need to lay out and get the consent of a patient for every side effect or complications of a drug or treatment.
Speaking in the Parliament on Monday (11 February), Dr Lam revealed this news when responding to questions from Members of Parliament (MPs) about the case of orthopaedic surgeon Dr Lim Lian Arn, who was recently sentenced the maximum fine of S$100,000 for not obtaining informed consent from his patient before giving her an injection.
Doctors had sent a petition to the Ministry of Health on the matter. Generally, doctors do not tell patients about side effects which are both transient and fairly rare, as with this injection.
MPs also raised their concern and asked if it is now mandatory for a doctor to get the consent of a patient for every possible side effect and complications, and whether this would cause doctors to practice “defensive medicine”. They also questioned the definition of the material information doctors are required to disclose to their patients.
“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,” Dr Lam said.
As for the case of the orthopaedic surgeon, he was not sentenced the hefty fine for not informing sufficient information to his patient, but rather because Dr Lim failed to inform his patient any side effects at all.
According to the guidelines, doctors are expected to reveal relevant and material information to their patients, while remote risks with minimum consequences will generally be seen as immaterial and need not be disclosed, said Dr Lam.
He said, "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."
"However, what is considered material information was not the issue before the DT (disciplinary tribunal) in Dr Lim’s case, and the DT did not apply the modified Montgomery Test as Dr Lim conceded that he had not informed the patient of any risks or complications at all," explained Dr Lam.
Dr Lam also admits that many “fair-minded” doctors would opine that the penalty imposed on Dr Lim was harsh.
"There has been considerable concern in the medical profession about the maximum fine having been imposed and that at one point suspension was considered. The concerns are understandable, when considering the facts and circumstances of this case,” he said.
The maximum penalty for such misconduct had been S$10,000 before it was increased to S$100,000 when the Medical Registration Act was last amended in 2010, he said.
However, Dr Lam added that the Sentencing Guidelines Committee that was appointed on 1 January would assist in ensuring consistency and fairness in the sentences meted, and improve transparency and rigour in the disciplinary process.
He also said that the Ministry of Health “does not want the (medical) profession to go down the path of defensive medicine”, besides acknowledging that the profession needs guarantee on what the legal position is and what the punishments are when disciplinary actions are taken.