Some practitioners fault new code for not being precise enough

SINGAPORE — While the Singapore Medical Council’s (SMC) revised ethical code and guidelines plugged some gaps in the previous edition, some doctors TODAY interviewed felt that several instructions were too open to interpretation and that it would be hard to hold practitioners accountable.

A plastic surgeon, who declined to be named, cited the guidelines on aesthetic treatment.

There is a wide gamut of cosmetic procedures with varying risks and side effects, but the guidelines address them as a whole, said the surgeon, who works at a public hospital.

For instance, what constitutes a “reasonable ‘cooling-off’ period” for each procedure is not spelt out, he pointed out.

Among other things, the SMC said a “reasonable ‘cooling-off’ period” must be in place for “more invasive and surgical” procedures to give patients time to consider their decisions.

General practitioner Leong Choon Kit pointed to the newly added section on telemedicine as another example. Telemedicine may range from a simple phone call to state-of-the-art equipment, he said.

“We don’t want to restrict our practitioners and the medical industry as a whole. We want to help them adopt new technologies,” he said.

In recent years, the issue of fee guidelines to prevent overcharging has been hotly debated, after the SMC had to remove its guidelines in 2007, which were deemed anti-competitive by the competition watchdog.

The SMC’s latest guidelines require practitioners to charge “fair and reasonable” fees but exact amounts are not stipulated.

Nevertheless, some practitioners reiterated that the council took the practical approach.

“So it is appropriate to say, leave it to the doctor to decide what is fair and reasonable,” said respiratory physician Ong Kian Chung from Mount Elizabeth Hospital.

To guard against disputes between patients and doctors, what constitutes “overcharging” must be agreed upon, said Dr Ong.

“If there are complaints of overcharging, then it has to be decided if the amount is fair. One way to do that is to ask the opinion of other doctors in the same specialty and of the same seniority. I usually try to explain to the patient beforehand, and if he or she still wants to go ahead, then there are less chances of dispute thereafter,” he said.

Dr Chia Shi-Lu, an orthopaedic surgeon who is also a Member of Parliament for Tanjong Pagar GRC, added: “It is like asking what is a fair and reasonable price for any commodity … If patients feel that they value the services and they know the fees beforehand, it is free will.”

Dr Chia, who chairs the Government Parliamentary Committee for Health, reiterated that the new guidelines tried to “draw a balance”.

“Do you make an ethics code that is as simple as possible, but broad? Or more prescriptive so it is clearer, but stands the risk of being outdated quickly?” he said.

Nevertheless, Dr Leong said the guidelines — which had not been updated since 2002 until now — should be reviewed more regularly, such as once every five years.

“The onus is also on practitioners to provide timely feedback and not wait for the SMC to come up with a review exercise,” he said.

“In the medical field, many changes and technological advancements can take place in just a few years.”