Doctors urged to step into patients' shoes

SINGAPORE - There may not be consensus on what informed consent constitutes, but for a good idea of what is needed, doctors should put themselves in their patients' shoes, said Justice Chao Hick Tin, vice-president of the Court of Appeal.

Speaking on the first day of the 37th Annual Medico-Legal Seminar 2012 yesterday, he said: "Putting yourself in the shoes of the patient, what would you have liked to know from the doctor in relation to the proposed treatment or procedure?"

If medical professionals kept to that motto, he noted, they would be unlikely to fall foul of professional and legal norms.

The distinguished speaker at the seminar, Justice Chao himself chose the topic, Recent Developments in Informed Consent.

Speaking to about 150 medical and legal professionals at the Raffles City Convention Centre, he said he chose this subject as he feels it is "still very much an issue" close to all doctors' hearts.

"Every doctor would like to do right," he said.

The prickly question of informed consent has made headlines several times in recent years, when patients complained, after some aesthetic, dental and surgical procedures had allegedly gone awry, that they did not know what they were in for.

Noting this, Justice Chao said the Singapore Medical Council (SMC) has had to hear "quite a handful of complaints made against doctors on account of an alleged lack of informed consent" in the last five years.

He highlighted three recent cases where this issue surfaced.

The first was that of colorectal surgeon Eu Kong Weng, the former head of the colorectal surgery department at Singapore General Hospital, who last year became the first doctor here suspended by an SMC disciplinary committee for failing to obtain proper informed consent from his patient.

The 45-year-old patient, a businessman, complained that Dr Eu had not mentioned any risks or complications associated with a procedure to treat piles.

The second involved eye doctor Low Cze Hong, who was fined $7,000 and censured by an SMC disciplinary committee in 2008 for not having had a balanced discussion with his patient on the risks versus benefits of a surgical procedure.

Justice Chao pointed out that in these two cases, the patients each signed a consent form.

But informed consent is not a matter of putting a signature to a form, but one of substance - the patient needs to understand the details and implications of what is being proposed, he said.

The third case involved Dr Lim Chong Hee of the National Heart Centre, who was charged with not properly recording a discussion with a patient on a possible lobectomy (removal of a part of the lung) in June 2007. He was fined $5,000 by the SMC this year.

"It cannot be overemphasised that you should always record in the case notes your discussions with the patient, at least in brief point form," said Justice Chao.

While judgments have already been passed in these cases, he noted that the law is constantly evolving to reflect the norms and interests of society, and urged his audience to "keep an open mind" so that any changes can be assessed in a rational and critical manner.

He supported this point by mentioning a report in The Straits Times in June, about how the Chapter of General Surgeons, a professional body representing about 170 practitioners, had created risk information forms for 26 common surgical procedures.

"I think this is progress," said Justice Chao, who noted that in June last year, a spokesman for the Singapore Medical Association had stated that "it is not the practice of many doctors and hospitals to list out the alternatives and their possible complications in writing when consent is obtained".

Seminar participant Nicholas Cheong, a lawyer, said the lecture gave him good reminders when advising medical professionals.

"Documentation is important, and there needs to be a dialogue with the patient which addresses (his) fears," he said.

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