No ‘information dump’: Watchdog says doctors only need to disclose what’s relevant and material to patients

SINGAPORE — Doctors only need to convey “relevant and material” information to their patients and do not need to inform them of all possible complications of a treatment or procedure, the watchdog of medical professionals said.

Seeking to calm an outcry over a recent disciplinary tribunal ruling, the Singapore Medical Council (SMC) said on Wednesday (Jan 30) that remote risks with minor consequences will generally be deemed immaterial, and do not need to be disclosed.

More than 6,000 people including doctors have signed an online petition that started last week, after orthopaedic surgeon Lim Lian Arn was fined the maximum S$100,000 for failing to tell a patient of the possible side effects of an H&L (steroid) injection he gave her.

The petition, started by another orthopaedic surgeon Tho Kam San, called for the Ministry of Health (MOH) to clarify its stand on the need for doctors to obtain “informed consent” from patients for minor procedures. 

Some doctors felt that the ruling could seriously impact how medicine is practised in Singapore, potentially leading to rising costs for patients.

In its clarification, the SMC said Dr Lim admitted that he did not tell his patient of any risks or complications at all from the injection.

The patient later developed "paper-thin skin" with discolouration and loss of fat and muscle on her wrist.

The council said: “It should be emphasised that Dr Lim was charged for wholly failing to inform the patient of any possible complications and not for failing to inform the patient of all possible complications that could arise from the H&L injection.” 

Dr Lim — whose treatment was appropriate — admitted that he should have told his patient of such complications, the SMC added.

In his mitigation plea, Dr Lim explained that it was an “isolated incident and wholly uncharacteristic of his usual clinical practice”, as he would normally outline all treatment options, including possible complications, to his patient.

He also gave anonymised case notes of other patients he saw before and after the incident, to show that he usually does so.

What information a doctor needs to give a patient, before a treatment or procedure, continues to depend on the specific circumstances of the case, including the patient’s particular situation, the SMC said.

The courts have clarified in a previous case that an “information dump” would not be appropriate and that a reasonable patient would not need or want to know every iota of information before deciding whether to undergo a proposed treatment, the council noted.

The tribunal that ruled on Dr Lim’s case said that it was not common for doctors to get specific written consent for H&L injections. It did not mandate such a practice, but indicated that it “would be good clinical practice to document in the case notes that a patient had been informed and was agreeable to the injection, a proposition which no doctor would reasonably disagree with”, the SMC said.

The tribunal’s decision serves to remind doctors to document that they have explained the treatment or procedure as well as the patient’s consent — not that doctors must take written consent for every minor treatment or procedure, the SMC said.

A 16-member committee appointed this year to look into sentencing guidelines for doctors will help to guide the sentencing process and ensure consistency across different cases, the council added.

Dr Lim’s lawyer had asked for the maximum S$100,000 fine or the minimum three-month suspension, while the SMC had sought a five-month suspension.

The tribunal imposed a fine and did not think it was fit to suspend Dr Lim because there were sufficient mitigating circumstances, the SMC noted.

Issuing its response on Wednesday night, the MOH said that it understands doctors’ anxiety and shares their concern that healthcare cost should remain sustainable for patients.

Last year, the MOH worked with the SMC to propose some amendments to the Medical Registration Act to further improve the transparency, consistency and timeliness of the disciplinary proceedings for both the public and doctors, a ministry spokesperson said.

“MOH welcomes feedback from stakeholders and we will continue to engage the medical community to see if we can refine our system further to provide greater clarity and certainty for doctors and patients,” she said.