Launch of Medical Protection Society Educational Services and 11th SMA Ethics and Professionalism Convention

19 Oct 2007

By Mr Heng Chee How

Venue: Shangri-La Hotel

Ladies and gentlemen,

I am delighted to join you today for the launch of the Medical Protection Society Educational Services and the 11th SMA Ethics Convention. 

Being a doctor is very challenging.  Apart from the need to keep abreast with rapidly advancing medical knowledge, doctors have to meet higher patients’ expectations so as to minimise the risks of complaints and even lawsuits.  With better education and access to health-related information on the Internet, patients often go to their doctors already equipped with some amount of medical knowledge.  Some patients may even have made up their minds on their choice of treatment but want doctors to reaffirm their decisions.  Patients also wish to have more information on the potential side effects of treatments and procedures, and are more likely to seek second medical opinion if they are dissatisfied with their doctors’ advice and explanations.  In situations where treatment results in poor outcomes, patients are also more likely to complain and seek explanations.   The MOH has, for instance, seen some increase in complaints against doctors over the years. 

The number of complaints and claims, higher claim quantums and legal costs are all possible factors that could raise indemnity premiums.  Based on data from MPS, the premiums paid by the various categories of medical professionals in 2002 was half that in 2007.  The implications of a highly litigious climate are severe.  For example, in many US states such as Pennsylvania, Nevada, West Virginia and Mississippi, high litigation rates have caused doctors to leave their practices because it is no longer financially viable to provide those medical services.  High litigation rates have also led to defensive medicine being more commonly practised in developed countries, thereby intensifying medical inflation.  Ultimately, healthcare consumers will bear such increased costs with no added benefit in terms of healthcare outcomes and quality.  While Singapore is not yet a litigious society, the healthcare industry must do more to address the issue and keep the situation under control. 

In this regard, I am pleased to learn that MPS has organised a Risk Consulting training programme to help doctors improve on their doctor-patient communication skills.  Indeed, studies have shown that patients often claim or sue because they are poorly informed about the benefits and risks of treatment, and are not given satisfactory explanations following adverse outcomes of treatment.  Patients also sue because they perceive their doctors as uncaring or insensitive to their needs.  These observations further emphasise the need for doctors to improve their communication with patients, not only in the course of providing medical care but also when adverse clinical events occur.  Doctors may hesitate to communicate following the occurrence of adverse events for various reasons.  Some healthcare providers may also underestimate the seriousness of disputes, perhaps thinking that offers of monetary compensation or waiver of fees may resolve the disputes.  When mishandled, more dissatisfaction is caused and the disputes escalate. 

With these considerations in mind, the Ministry started a Medical Mediation Scheme, which is currently in its pilot phase.  This scheme is a collaboration between MOH and Singapore Mediation Centre to incorporate mediation into the public healthcare complaints management framework.  Mediation is used widely in many countries today to resolve different kinds of disputes, including healthcare disputes.  Mediation uses a neutral third party to help parties in dispute come to a mutual agreement through a non-adversarial process.  This lowers costs of resolution compared with litigation, and has a higher likelihood of not destroying the relationship between the disputing parties. 

Under the Medical Mediation Scheme, parties with healthcare disputes are encouraged to mediate at the Singapore Mediation Centre if initial negotiations fail.  The mediators at the mediation centre will be guided by medical panel experts when mediating the disputes.  The scheme caters to the bulk of healthcare disputes where claims do not exceed $30,000.  The costs of mediation will be shared between the disputing parties.  With this scheme in place, aggrieved patients and their families are provided an added avenue to obtain clear explanations from the institutions, as well as to arrive at a fair settlement. 

Of course, mediation alone is no guarantee against the risks of litigation.  Healthcare providers should regularly review their processes, identify potential areas of medical errors, and fix those weaknesses.  Systems for monitoring and analysing adverse events and near-misses such as the Sentinel Events Reporting System and Root Cause Analysis should be put in place to prevent repeat occurrence of medical errors and to improve patient safety.  Responsible clinical stewardship and governance in the healthcare institutions are also essential ingredients for enhancing patient safety and promoting a culture of continuous improvement. 

At the individual level, doctors must do their part by remaining competent and keeping abreast of medical developments, and practising their craft with utmost regard for professionalism and ethics.  This would include practising within their scope of competence and not performing unsafe or medically unsubstantiated procedures. 

I am informed that MPS, as an indemnifier of health professionals, also discourages unsubstantiated practices by not extending indemnity coverage to such practices. 

By adopting a holistic approach toward quality improvement, risk minimisation and dispute resolution, we can deal sensibly, productively and fairly with the expectations of a better educated and information-empowered population, and the implications of fast changing technology and science.

On this note, I am pleased to hereby launch the MPS Educational Services and the 11th SMA Ethics Convention. Thank you.