SMA seeks clarification from SMC following the Grounds of Decision of the Disciplinary Tribunal Inquiry for Dr Lim Lian Arn
When the Grounds of Decision for this case were published, SMA Council wrote a letter to Singapore Medical Council (SMC) on 24 January 2019 to share comments expressed by its Members about its implications. Following the letter, the SMA Council met with SMC on the evening of 25 January 2019 to better understand the reasoning behind the judgement and penalty, and to discuss practical implications to clinical practice that now arise in consequence. A second meeting, also with the SMC presenting, was held on the evening of 31 January 2019 together with the leaders of the Academy of Medicine, Singapore and College of Family Physicians Singapore.
At both meetings, SMA and other participants pointed out to the SMC that given that the complications experienced by the patient from the minor procedure were neither permanent nor debilitating, and as the harm which ensued was limited in nature and extent, the penalty of $100,000 seemed disproportionate. Questions were also posed to the SMC about their views on what the appropriate benchmark sentence(s) for failure of informed consent cases ought to be.
Regarding minor procedures, three very important points of everyday practice now needed clarification: First, precisely which minor procedures could be done just under implied consent; second, how comprehensive was the information that needed to be communicated, including under implied consent; and finally, whether documentation in the case-notes was now mandatory (as opposed to merely good practice), including for cases done under implied consent. Unless definitively clarified, such uncertainty would only encourage the practice of defensive medicine, which would not be in the interest of either doctors or patients.
We also pointed out the current ambiguity and resultant practical difficulties facing the junior doctors over consent taking for minor procedures, and how, without proper guidance, the time required for defensive medical practice would eat into what was presently available for routine patient-care. This was summarised in the letter to the Straits Times Forum on 11 February by the Chairman of SMA's Doctors-in-Training Committee, Dr Benny Loo. The letter can be found at http://bit.ly/2DvdrBJ.
Other issues discussed included how some members of the Complaints Committee and Disciplinary Tribunal might benefit from more formal training in aspects relating to how to consider expert opinions and how to judge fellow doctors. An offer by the SMA Centre for Medical Ethics and Professionalism to work together with the SMC was accepted for consideration.
The SMA Council will continue to engage with the SMC and to advocate for greater clarity and guidance on consent taking. We will keep Members updated as new information becomes available.
SMA committee against harassment
SMA recently formed a committee to look into the issue of harassment at work. As a start, the committee plans to publish a series of articles in SMA News on this matter. We also look forward to engaging external stakeholders to organise activities and initiatives. We hope to raise awareness regarding harassment and help reduce the occurrence of such incidents in the workplace.
Predatory publishing
The issue of predatory publishing was highlighted by the Singapore Medical Journal (SMJ) Editor-in-Chief, A/Prof Poh Kian Keong, in his January 2019 issue's editorial. Predatory publishers typically ask for high upfront publication fees without providing robust peer review or editorial services. There have been several cases where SMJ had to decline submitted manuscripts which have been published in predatory journals without the authors' knowledge. We encourage readers to find out more about predatory publishing and avoid the pitfalls. The full editorial can be found at http://bit.ly/2tdxmQR.