Doctors giving advice — a follow-up.
Because theory and practice are 2 different things.
I. What if the patient only speaks a dialect I don’t understand? Surely I’m not expected to give medical advice to such a patient?
In this case, you already have a problem even before we discuss medical advice. How can you even diagnose the patient’s medical need (which is the first aspect of medical care) if you can’t communicate with the patient? And do you really want to take the risk of being misunderstood by the patient?
So there’s no easy solution — either find a way to translate, or refer the patient to another doctor. Note also that under the SMC Ethical Code and Ethical Guidelines [Link] :-
a) when referring a patient to another doctor, you must inform your patients of the reasons for the referral and provide relevant information about the other doctors [Article A4(3)]; and
b) you must ensure that patients understand the information you give for the
purpose of consent. If there are language difficulties, you must use
interpreters [Article C6(9)].
II. This is too troublesome. If the patient comes in with a family member who can translate, can’t I just explain to the family member and let the family member translate?
You can, but it is still risky. What if the family member gets the translation wrong? In that case, the information may not have been provided to the patient, and there may be a breach of your duty to provide medical advice.
At the end of the day, you have to decide, based on your medical practice :-
a) how often you need a translation;
b) whether the frequency of translation needed justifies hiring a translator; and
c) if you choose not to hire a translator, whether you are prepared to take this risk.
Or just practice in a Polyclinic where you can ask for assistance from clinical assistants (who I assume are competent interpreters. I’m not endorsing their abilities!)
III. Do I really have to record the advice given to patients? It’s for them to take note of the advice given right?
Yes. This is non-negotiable if you want to protect yourself from lawsuits.
First, what if there is a dispute between you and the patient as to the advice given? Do you really want to put yourself in situation where it is your word against the patient’s?
Second, it is an ethical requirement under the SMC Code / Guidelines [Article B3] :-
Maintaining clear and accurate medical records enhances good patient care and ensures high quality continuity of care. Keeping good medical records means:
(1) You must maintain clear, legible, accurate and contemporaneous medical
records of sufficient detail to enable a high quality of continuing care.
(2) You must make your records at the time of your engagement with patients, or as soon as possible afterwards.
(3) Your medical records must include all clinical details about your patients,
discussions of investigation and treatment options, informed consents,
results of tests and treatments and other material information. If you are
delegated an aspect of care, you may confine your records to what is
relevant to your portion of care.
IV. This patient is mad and is screaming at me! What do I do?
Please don’t scream back at the patient. SMC Code / Guidelines [Article C1(3)] :-
You are not obliged to be subjected to abuse of any kind by patients or
those with them. Yet, you must maintain a professional demeanour
towards patients at all times. Except in cases of self-defence against
physical harm, you must not retaliate but seek to end the engagement with
the patients as quickly as possible.
Yes, I know this is super unfair and troublesome. I don’t envy you!
V. Can I offer to pray for my patients?
I think you can. SMC Code / Guidelines [Article C3] :-
(1) You must not foist your personal beliefs upon patients or express your
beliefs in ways that exploit patients’ vulnerabilities or are likely to cause
distress or offence…
(3) In general, it is better not to personally provide spiritual counselling to your patients, to prevent misunderstanding and loss of objectivity. But if patients request it from you and you decide to personally provide spiritual
counselling or support to your patients, you must ensure that your objectivity, judgment and professionalism in medical decision making are not compromised to patients’ detriment.
My interpretation of these ethical rules is that you should not preach to patients or tell them to go to church / temple / mosque / synagogue / etc. But at the end of the session and after proper medical advice has been given, I see no issue with offering to pray for a patient in your own time. That is a reflection of your own personal beliefs that (a) does not foist the beliefs upon the patient; (b) does not affect the care given to the patient; and (c) is not spiritual counselling.
But of course, if you want to play super safe, don’t offer to pray for your patients. Your call!
VI. One of my patients has captivated my heart. He / she is everything I want in a life partner. Can I ask him / her out on a date?
Oi, this is not an agony aunt column! Also, no! See Article C12. You should know better!
As usual, do get in touch if you’d like to discuss further, this is not legal advice, for general information only, etc etc.
