Addressing What a Doctor Cannot Do Alone

Lee Pheng Soon

Dr Lee Pheng Soon was first co-opted into the 33rd SMA Council (1992/1993) by Dr Giam Choo Keong. Dr Low Lip Ping (author of the Opinion article on page 14) was a fellow Council member. Dr Lee has continued as an elected Council member from the 34th Council to the present 64th Council. He was SMA President for three years, starting from the year of the SARS outbreak in 2003, and was the first doctor to attain 20, then 30 years of continuous service as an elected Council member. To mark his 30-year Long Service Award, SMA News invited Dr Lee to reflect on his experiences with the SMA, and share what he sees as the role of SMA in these rapidly changing times.

The Ministry of Health (MOH) recognises more than 15,000 doctors and acknowledges three Professional Bodies: the Academy of Medicine, Singapore; the College of Family Physicians Singapore (CFPS); and the SMA. SMA was first set up in 1959, and its achievements have been well documented in its 60th anniversary issue ( Over these 65 years, different Presidents and Councils have had different visions for "what SMA means". The earliest vision is written in SMA's crest: "Jasa Utama" (Malay for "Service before Self"). In 2015, a new slogan was adopted, "For Doctors, For Patients", acknowledging SMA's expanded scope in society.

If you were to ask individual doctors, "What does SMA mean to you?", you would get many different responses. In this increasingly complex world, every doctor inevitably encounters situations where even his/her best efforts will be insufficient. In clinical matters, a doctor can refer to more specialised colleagues for advice, but in matters relating to the practice ecosystem, one can only turn to his/her professional body. In good causes affecting doctors and patients, where an individual doctor cannot do what is necessary for himself/herself, the SMA should stand in for him/her. I see this as SMA's duty, perhaps even its raison d'etre.

I first witnessed this in real life in the field of medical indemnity 22 years ago, when the SMA President, Council members and its Honorary Legal Advisor battled to help 1,800 doctors in serious trouble – more serious than they perhaps even understood then.

When doctors meet trouble

Every doctor needs indemnity against malpractice. A/Prof Goh Lee Gan expressed it thus: "[T]here are the unavoidable mishaps that happen in medical practice. Things will happen, whether because of misadventure or bad luck. As the Chinese saying goes, 'If one were to go up the mountain often enough, one would meet the tiger.'"1

To this I would add: "As the doctor neither knows when he will meet the tiger, nor how ferocious the tiger will be, he needs a reliable partner who always has his back, and who carries enough bandages and a tourniquet for his wounds after the fight." In other words, malpractice indemnity for the doctor must be good and reliable, and should provide uninterrupted cover – from the first day of work as a house officer, till the expiry of the statute of limitations years after he/she has retired.

When Singapore doctors suddenly lost protection

In real life, doctors can only do three things regarding indemnity: choose their indemnity provider, pay their premiums faithfully and pray nothing major goes wrong with their provider. But what happens when something major does happen? In 2002, I saw first-hand how one-third of Singapore's doctors were affected by the failure of their indemnity provider, how it left them helpless as individuals practising without cover, and how the SMA represented them to find a solution not available to themselves as individuals.

Until 1999, the two main providers in Singapore were Medical Defence Union (MDU) and Medical Protection Society (MPS), both based in the UK. In September 1999, MPS absorbed MDU's Singapore portfolio, when MDU withdrew from Singapore as part of a global reorganisation. To allow doctors a choice in future years, SMA President A/Prof Goh Lee Gan invited Australia's largest medical insurer, the 109-year-old United Medical Protection (UMP) to be a second indemnity provider in Singapore. Unexpectedly, UMP failed in 2002, and "a third of Singapore doctors (1,800 doctors) were left running for cover".2

The impact on these UMP-insured doctors was like a perfect storm: support for incidents already reported was suspended (though this was eventually honoured), incidents that had occurred but had not yet been reported ("IBNR") immediately had no cover, and doctors had to work without any indemnity cover. Even buying a new policy immediately would not provide cover for the gap between the end of UMP coverage and the start of the new policy (known as the "nose period"). This was really bad, and to some doctors with reported incidents or IBNR, it could amount to financial disasters.

No doctor could do anything about these body blows as an individual. I know; I was one of them.

SMA steps in to help

As an organisation, SMA had resources and connections that allowed it to attempt efforts not available to individuals. After confirming that neither the MOH nor Ministry of Foreign Affairs were in a position to help, SMA sent Dr Wong Chiang Yin (who was already in Australia for other reasons) to meet with UMP management to clarify the precise position that Singapore doctors were in. It was not good.

Then, "on 2 May, the SMA Council, at an extraordinary Council Meeting, decided to be proactive and to look for alternative cover. So, directions were given to talk to two parties - MPS and NTUC Income. Dr Lee Pheng Soon spearheaded the MPS venture and asked for prospective and nose covers. A/Prof Goh [Lee Gan] spearheaded the venture with NTUC Income, and held discussions with Mr Tan Kin Lian, CEO of NTUC Income, about providing medical indemnity cover for doctors."1

In the event, MPS generously extended nose coverage without additional cost, and the many former UMP-covered doctors who took up MPS membership were immediately covered prospectively and retrospectively. NTUC Income offered lower-priced claims-made policies to doctors. This resolution pulled together by SMA was imperfect, but it left no doctor more exposed than before UMP's collapse, and it secured a future with adequate indemnity protection for the profession. In a dialogue session on 2 September 2002, SMA's Honorary Legal Advisor Mr Lek Siang Pheng remarked that, in terms of indemnity cover moving forwards, the situation of two available alternatives, namely MPS and NTUC Income, was similar to that in 1999. Twenty-one years later, I still remember him burning the midnight oil for months, supporting us.

Finally, in September 2005, UMP contacted 1,314 Singapore doctors and offered a pro-rated refund of their subscriptions in return for a deed of release. From then till now, SMA has continued to work at improving the quality of indemnity options available to Singapore doctors. One such effort included providing input to the eventual form of the present indemnity covering all doctors employed by Ministry of Health Holdings, currently run by insurance broker Marsh.

Other examples of SMA's contributions

Though it was dramatic and affected many doctors, the 2002 indemnity crisis was not the only instance where SMA, as an organisation, actively stepped in to support doctors when they struggled as individuals.

Some such instances recalled by fellow Council members, past and present, are shared in the table on the facing page

There are many more situations where SMA had helped when individual doctors could do nothing. Some were futile situations where it was important just to put SMA's position on record. Nevertheless, I think it is fair to say that in the past 30 years, SMA has not been neglectful in this one area of work: stepping forward and doing things that individual doctors cannot do by themselves.

Concluding thoughts

Every month, the SMA Council receives a few resignations from Members. The most common reason given is "I am not getting any value for my annual subscription."

There is a lot of truth in that. The annual subscription could be used for something else. For example, to a stressed-out doctor seeking entertainment, the SMA cannot possibly compete with 20 cinema tickets a year.Even so, I urge all of us to change our mindset and think instead: it is not about what SMA can give me, the individual doctor, but it is about what SMA can do for all doctors when individuals are powerless. The record is clear – decade after decade, SMA has repeatedly stood up for the medical profession, especially when the individual doctor is helpless in the face of an unfair or unjust situation affecting either doctors or patients. Very bluntly put, it is a matter of SMA needing our support, rather than what we can get out of SMA for ourselves. So let us all stay engaged and help by supporting SMA's work silently or, better still, by participating actively. Remain in and recharge your SMA. Encourage your President and your Council members, as they continue working for doctors and for patients. And please never forget: if it is to continue doing more for everybody, the SMA needs you.

Revisions were made to the table on 27 June 2023. 

  1. Goh LG. The Inside Story of UMP Singapore. SMA News [Internet]. September 2002. Available at:
  2. Tan HL. Doctors look for cover. TODAY. 5 July2002. Available at:

Lee Pheng Soon is from the fourth generation of doctors in his family. His maternal great-grandfather and his paternal grandfather were graduates of the 2nd (1911) and 9th (1918) cohorts of Singapore's Medical School. Their descendants served the SMA with distinction, including as former Presidents. Now retired from a career in Pharmaceutical Medicine, Dr Lee continues this tradition, serving the community as a HDB Family Physician, and the Medical Profession as a SMA Old-Timer.


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