Are more doctors getting into trouble?

PHOTO: Are more doctors getting into trouble?

SINGAPORE - Doctors are often admired figures. So when one gets into trouble, it's news.

Last week, consultant hand surgeon Looi Kok Poh admitted liability in a negligence case after he did an extra procedure without his patient's knowledge.

Instead of admitting his fault, Dr Looi had got a nurse to alter the patient's consent form to include the additional procedure.

A provisional judgment against Dr Looi has been given and a date will be fixed for a hearing on damages to be assessed.

Dr Looi is not the only doctor who has been in a spot of trouble lately.

The Straits Times reported last month that the number of patients suing Singapore surgeons has nearly doubled over the past five years.

Financial awards were made in more than half the cases filed.

Last year, 10 doctors in GP clinics were penalised by the Singapore Medical Council (SMC) for inappropriate prescription of benzodiazepines, a class of hypnotic drugs used to treat a variety of conditions, including insomnia and anxiety.

And so far this year, there has been an average of one case a month of doctors being penalised for lax benzodiazepine prescription.

The SMC disciplinary committee has called the over-prescription of benzodiazepines "particularly troubling".

Lax prescription of such drugs is dangerous. Long-term consumption may lead to addiction as well as drug tolerance, with patients requiring increasingly higher doses of the drug for it to be effective.

In a July press release after a disciplinary inquiry that slapped a $10,000 fine and a six-month suspension on Dr Ng Chee Keong, for prescribing "potentially dangerous" quantities of sleeping tablets to 11 patients, the committee said such cases should be treated seriously to warn other doctors, "given the rising incidences of such undesirable conduct".

Still, the number of errant doctors has not gone up significantly, in relation to the total number licensed to practise inSingapore.

In 2007, with almost 7,400 doctors here, there were seven disciplinary inquiries. Last year, the number of doctors licensed to practise had gone up to just over 9,500. And there were 10 disciplinary inquiries.

Government Parliamentary Committee for Health chairman Lam Pin Min said the higher number of inquiries could be due to the increase in the number of doctors practising here, as well as the SMC clearing abacklog of such cases over the past fewyears.

He said: "In addition, with increased affluence and a better educated populace, patients are more aware of their rights.

"Singaporeans also tend to read up more about their medical conditions and the treatment modalities before consulting the doctors.

"Many would have surfed the Internet, (so are) more well-read and informed and thus have higher expectations from the medical practitioners," said Dr Lam.


Associate Professor Goh Lee Gan, immediate past president of the College of Family Physicians Singapore, does not think there is a substantial increase in the number of errant doctors.

He said the proportion of doctors excessively issuing benzodiazepines is going down in the overall number of doctors on register with the SMC.

"There are always some doctors who are misguided, but by and large, it's not so rampant because they know what should be done," said Prof Goh.

Ethical Code

An SMC spokesman said doctors need to adhere to the Ethical Code and Ethical Guidelines issued by the Ministry of Health (MOH) and SMC on the prescription of benzodiazepines.

The guidelines are published on the SMC website and are used to assess the doctors' actions, so the onus is on them to stay updated.

Just as there are errant doctors, there are demanding patients.

Prof Goh has come across patients who even try to teach him about prescription rules.

He said: "They say 'There's no more restriction since six months ago' and I go 'Where did you hear that?' Once they know that you know your stuff, they back off."

Still, given the number of cases of disciplinary action making the news, will Singapore's reputation as a regional medical hub be affected?

Dr Lam said: "In any profession, there will always be errant practitioners who may try to go around the rules or even blatantly violate them.

"It is important not to view such cases in isolation but rather to compare the incidence locally to the incidence overseas.

"If there is indeed an increasing trend, MOH will need to find out the root cause and come out with more measures to prevent further violation.

This article was first published in The New Paper.