In the last four years, many more such groups have been formed and registered with the Registrar of Societies. One such registered society was the Bone Marrow Donor Programme, formed in 1993 by the parent of a young boy who died from leukemia. The child might otherwise have benefited from bone marrow transplant had the service been in place. The society set up by this group of lay volunteers aims to establish and maintain a register for bone marrow donors, to fund transplants and to finance research. It has achieved considerable success through the dedicated work done by its members.

As a result of activities of societies like these, public awareness of diseases have increased. Patients who are suffering from these diseases can organise themselves into self-help groups and interact with doctors through various activities organised.

There are however certain issues which the medical profession need to pause to reflect on, viz:

(i) how these support groups should work with sponsors especially in activities which might be seen as promotion of the sponsors’ products or services;

(ii) the question of scale and logistics; and

(iii) the doctors’ role in such organisations.

The first concern has in fact been raised by the President of one of these newly formed societies, Dr Leong Keng Hong, of the Osteoporosis Society (Singapore). In the January 1998 issue of his society’s newsletter "Bone" he wrote, "We do not endorse specific products but would willingly work together to increase awareness of accurate facts about osteoporosis. Currently there are other support groups for osteoporosis and we welcome their contribution. But one must be wary of activities that are designed to promote a particular product or service".

Doctors in these societies have to be circumspect regarding sponsorship. The guidelines on the relationship between the medical profession and the pharmaceutical industry to be launched in November can be referred to for guidance. In this category, one could also include activities that seem to promote only certain doctors.

The second concern is that of scale in a city-state like Singapore. The question often asked is whether we need to form a separate registered society for each disease entity. We cannot emulate countries like the US where vast community resources are available and the number of people who suffer from any particular disease is large. Should patients and doctors interested in doing something about a particular disease in Singapore not align themselves with an established society with broader perspectives? This move will definitely reduce the burden in trying to fulfil the administrative and other accounting requirements of the Registrar of Societies for separately registered societies. Furthermore, if the proliferation of such small groups was not checked, there would be a dilution of resources, wasteful competition for sponsors and duplication of facilities.

The third concern is the role of doctors in these societies and their ethical responsibilities. It is encouraging to note that certain doctors have taken the lead to help set up these societies. They have assumed key roles by offering their medical expertise and leadership. However, it is also their public responsibility to nurture and encourage leadership by non-doctors. It is also incumbent to involve other doctors not directly linked to their institutions or to their discipline. This is to ensure broad base support of the medical community and continuity in providing medical advice. Established community societies such as SATA or Singapore Cancer Society have non-doctors as leaders with doctors providing expert advice. Other societies, like the Diabetes Society of Singapore involve doctors at all levels. Such trends must be encouraged.

An insurance scheme, unlike the 2 professional indemnity schemes, is based on claims-made basis, and not incident-occurence basis.

1. Claims-made basis

When a doctor purchases the insurance scheme, he is covered only if he is in continuous coverage under the same scheme when the claims are made. For example, a mishap with a case of appendicectomy may occur in 1998 but the doctor may only receive the first letter from either the police or the lawyer in 1999. If the doctor is no longer insured under the same insurance company in 1999, he will manage the legal problems using his own resources.

The premium of such a scheme is usually lower as it is only concerned with litigation at the current level.

2. Incident-occurence basis

A professional indemnity scheme will undertake to assist the doctor for any number of years after the occurence of an incident, even when he is no longer with the same professional indemnity company when the claim is made against him. This is provided that the doctor had subscribed to the medical indemnity scheme during the said year when the incident occurred.

The premium for this type of schemes is necessarily higher than those on claims-made basis due to rising trends of litigation, and the element of inflation of the claims made against the doctor over time.

We hope this will adequately explain the differences between the 2 types of policy.