Doctors and informed consent — a tale of a $100,000 fine
So expensive.
I. Summary please!
An orthopedic doctor gave a patient an injection. He did not tell the patient about the possible side effects. Side effects occurred. He was fined $100,000 by the Singapore Medical Council (“SMC”) disciplinary tribunal. [Link]
II. Wah. I am a doctor and this is super unfair.
You’re not the only one that thinks so — check out the lively discussion on Reddit, for example. [Link]
III. So I might as well just quit medicine and sell teh tarik right?
Hold on! /u/Durainboy is very passionate in his/her views but things are not as bad as they seem. Let’s break it down. Again, this post assumes that you’re a doctor.
In the first place, I’m not sure if this is something “so minor”. If the proposed treatment can lead to more pain than the injury itself, and there is the risk of losing muscle tissue, isn’t this something that the patient should know so that the patient can make an informed decision on whether to undergo this particular treatment, and particularly when there is an alternative treatment?
Further, the initial complaint did not seem life-threatening. In that case, shouldn’t the patient be informed of the risks in the proposed treatment so that the patient can decide whether or not he/she even wants to undergo the treatment?
Also, whether or not the patient comes to “serious harm” is not the point. Suppose you are a financial advisor and you advise me to buy a certain product. I buy the product. Later on, I liquidate the product at no loss. I then find out that the product was risky and I would never have bought the product if I had known it was risky. Sure, I did not suffer any harm. But shouldn’t there be safeguards to ensure that I was not exposed to this risk in the first place?
Finally, will this decision lead to more defensive medicine being practiced? That is a much longer topic. But note that the usual concern with defensive medicine is whether the doctor ordered unnecessary tests or over-treated the patient as a defensive measure. In this case, the doctor failed to explain a risk to the patient. Explaining risks in treatments is something that should be done by default and I don’t see why this should be discouraged.
While I am not so sure that this is a “minor infraction”, I agree that 5 months is a very long time. I don’t blame you for feeling that SMC is not protecting doctors. Let’s discuss this further below!
Woah woah woah. Now this is not correct. There is no need to tell patients that there is a 0.0001% chance of dying from taking Panadol, because a very severe consequence may not need to be disclosed if its chances of occurring are so low that the possibility is not worth thinking about. Check out my previous post on this. [Link]
Besides, you already have a mechanism for preventing people from dying from an allergic reaction to Panadol. Before prescribing medication, don’t you ask the patient whether he/she has any drug allergies?
Also, you can’t just spam the patient with information, if this means that the patient ends up not understanding the options and the risks. So “just give the patient all the information” is not a solution as well.
IV. Dude you’re not a doctor. You don’t understand.
Absolutely correct! I am not a doctor. But I am, on occasion, a patient.
As a patient, I recognise that there are often various treatment options. I value my doctor’s advice as to the best treatment option. But I still need to know the risks before deciding on the course of treatment. At the end of the day, the person exposed to the risk is me, and not my doctor.
The effect of the SMC disciplinary tribunal’s decision is that doctors will have to be more careful in ensuring that patients are aware of the risks involved in proposed treatments. I am extremely sympathetic towards Dr Lim — as far as I can tell, he is a good doctor and a decent person. But it is a core part of a doctor’s responsibilities to advise patients of risks involved in treatment.
V. Why is the SMC out to get us? I’m just trying to make a living here!
I know you’re just trying to make a living. I know there are not enough hours in a day. I know that you’re already trying to find the right balance between keeping patients informed, and not spending unnecessary hours with every patient. I can empathise.
But SMC appears to have made a policy decision that informed consent is a Big Deal. So please don’t ignore this SMC tribunal decision. And do consider if you need to make changes to your standard practices in order to keep your nose clean.
Stay safe folks!
Further reading :-
Commentary: How should we regulate doctors and protect patients in a complex world? [Link]
SMC Ethical Code and Ethical Guidelines [Link]
As usual, this is not legal advice, for general information only, I haven’t found the actual grounds of decision and this post is purely based on the news report, etc etc.
