Angry Doctor

Friday, March 03, 2006

Doctors' Charter?

In her letter to the ST Forum published on 28 Feb, Dr Helen Tan wrote:

"Patients complain about doctors all the time. But is there an avenue for doctors to address their grievances? Who can we complain to?

We need a doctors' charter to look into the rights of doctors."

I didn't write on this topic because I thought it wasn't necessary to have a Charter, since we supposedly have the SMA fighting for us. But this letter in the ST Forum today made me thin about the issue again.

Why do doctors need a charter when they have taken Hippocratic oath?

I FIND it strange that Dr Tan Hui Mien, Helen should call for a doctors' charter ('Need for a doctors' charter', ST Online Forum, Feb 28) when doctors take the Hippocratic oath before they start to practise.

The profession of healing and saving life is different from the work of trading goods. Teaching, for example, is a noble profession that commands high esteem. No teacher would ask for a teachers' charter to look into the rights of teachers.

The relationship between doctor and patient is similar to that between teacher and student. Both professions call for compassion and understanding.

Patients and students always respect doctors and teachers respectively as people of high moral standing. The laws of the country protect both sides. A charter is required only when the laws are not favourable or not adequate for one party.

If a doctor cannot establish a good relationship with his patients, he needs to reflect on what is missing and not what is needed to protect his interests.

Should patients require a charter to look after their interests too?

Paul Chan Poh Hoi

Now that's like asking why women need the Women's Charter when they already have their wedding vows.

Why do we need laws to protect the battered wife when the husband has already promised to love and cherish the wife till death do them part?

Saying: 'If a doctor cannot establish a good relationship with his patients, he needs to reflect on what is missing and not what is needed to protect his interests' is like asking a battered wife to reflect on why she deserves to be beaten. Just as not all husbands are loving and non-violent, not all patients allow a good patient-doctor relationship to be formed between themselves and their doctors.

In any case, nothing in the Hippocratic Oath says the doctor cannot defend himself against unfair accusations from the patient, which was Dr Tan's main worry.

Mr Chan himself had written: A charter is required only when the laws are not favourable or not adequate for one party. I believe it is exactly this sentiment that prompted Dr Tan and others to write to the Forum, and for Dr Tan to call for a Charter.

The reason why there was a need for legislation on domestic relationship is because of the fact that the family relationship has broken down such that we cannot rely solely on traditional sense of obligations and duties to protect all parties in a family. Has the patient-doctor relationship come to that stage?

The legal responsibilities of the doctor to his patients has existed since the first laws of Mesopotamia had been engraved in stone, and malpractice today is a field of its own in legal practice, so I don't think we need further legislation to protect the patients or to detail doctors' obligations.

What we seem to be lacking is the sense and awareness of the patient's duties and obligations. So maybe Mr Chan's idea of a Patients' Charter, in which is spelled out a patient's rights and obligations in a patient-doctor relationship, including what the limitations are on liability on the part of the doctor in case of the patient's non-adherence and non-compliance to treatment, as well as what forms of complaints on a public forum against a doctor may be held as defamatory and not covered under 'special privilege', has its place too.

Will it happen?

I think it will eventually, if we do not address this perceived imbalance in the rights and obligations between patients and doctors felt on the part of the doctors.

Do I want it to happen in my life-time?

Well, let me put it this way: do YOU ever want the Women's Charter to be invoked in YOUR marriage?



  • Good stuff angry doc!

    I like the comparisons between a doctor's or patient's charter to that of the women's charter and the vows of marriage and all....

    Very relevant.

    Frankly I think no amount of charter will replace a nice "clear-the-air" discussion between husband and wife/doctor and patient with the aim of clearing doubts and differences.

    Fight here fight there will get no where.

    By Blogger Dr Oz bloke, At March 03, 2006 1:57 pm  

  • Patients and students always respect doctors and teachers respectively as people of high moral standing.

    Tell that to the patients and students who abuse their doctor/teachers.

    As in MCQ, always is almost always wrong.

    20 yrs ago, patient to sleep deprived doctor " Yrs is a noble profession"

    Now: " U are unprofessional for not being fresh and awake and I am going to sue u"

    By Anonymous Anonymous, At March 03, 2006 2:54 pm  

  • Dear Gary,

    You are correct. Wah you like that already in M5.....I can't imagine how you are going to be as a houseman.

    Nowadays got a lot of feedback forms for patients you know. I used to have a friend who got so many complaint letters, all the head of departments know him.

    He is now a medical administrator.

    Looks like you've chosen the correct path.

    By Blogger Dr Oz bloke, At March 03, 2006 3:01 pm  

  • The truth hurts and I am amused at what some of my naive classmates think about their future careers.

    Nobody owes u a living and u better prepare to add value in what u do to survive in future.

    Specialists are going to lose their chronic patients once their patients see family physicians (compulsory for GP to become pseudospecialists but charge the same)

    Radiologists are going to face problem with teleradiography from india.

    Surgeons (neighbouring competition eye surgery cheaper in Thailand than Singapore, few Walter around that can be known as world class plastic surgeon in Singapore)

    Administrators (low pay and no respect but small chance to enter corporate world)

    The end of medicine is near.

    By Anonymous Anonymous, At March 03, 2006 3:20 pm  

  • i don't get Mr Paul Chan's Hippocratic Oath link.
    you mean Hippocratic Oath protects doctors meh?

    angrydr, u should write into ST forum and complain about bad patients.
    or at least point out the flaws in mr paul chan's letter.
    i'm surprised ST printed his letter.
    no link!!

    "If a doctor cannot establish a good relationship with his patients, he needs to reflect on what is missing and not what is needed to protect his interests."

    why is it always the dr's fault ah?

    i don't believe the end of medicine is near.
    but also don't take ur patients for granted.

    By Anonymous Anonymous, At March 03, 2006 3:34 pm  

  • have you ever considered the field of alternative medicine?

    I'll tell you that field is very lucrative!

    But you don't want to practise that in Singapore. Within asia, Thailand is currently a good place for that.

    With a Singapore MBBS people in the region tend to respect you more also. You'll be surprised to find out that it does work in certain patients for certain conditions.

    Nutritional therapy, Gershon Therapy, Chelation Therapy, Colema boards, TCM, Cell Therapy...

    Like you said, add value. There are many many many opportunities out there. Just that most NUS medical undergrads never bothered to push the boundaries and explore. Understandably so also because of the nature of our education system.

    Cheers Gary!

    By Blogger Dr Oz bloke, At March 03, 2006 3:35 pm  

  • I don't think medicine will 'end', but I believe the face of medicine will change as it has always been doing.

    If you mean 'end of medicine' as a lowering of doctors' earnings, then I suspect that may be true and not necessarily a bad thing.

    For the time being, I believe we should 'value-add' to our practice by restoring the dignity of the profession.

    If we clean up our own house and practices, and present a united front to show that we are a profession that gives no nonsense and will take no nonsense, then we will regain the respect of the populace - and mutual respect is the foundation of a functional patient-doctor relationship. If you have to wonder if the doctor is competent or if he is going to con you each time you visit him, wouldn't you behave the way the complainants have too?

    Will it work? Who knows? At least it's easier trying to improve yourself than others.

    By Blogger angry doc, At March 03, 2006 5:06 pm  

  • m2, judging by Mr Chan's letter, I wonder if he knows the contents of the Oath even.

    Nevertheless, his letter shows us the view of a layman (how common it is I am not sure): that just because the doctor's profession is a 'compassionate' one he must relinquish his rights to defend himself. Whether or not such is actually in the text of the Oath is really irrelevant. Even if you pointed out to a layman that the right to self-protection is not waived under the Oath, the layman who expects it to be so will probably just demand that it be added in.

    As for it always being the doctor's fault, I actually used to believe it was so.

    If the patient cannot be persuaded to comply with the lifestyle changes and treatment required, surely it is the doctor's failure to enlighten him?

    But really, absolute blame can only be assigned if the doctor is also given absolute power over the patient's life and body. We must achieve that balance between benign paternalism and patient autonomy, and that balance is different for each patient.

    By Blogger angry doc, At March 03, 2006 5:16 pm  

  • Quite effective info, thank you for the post.
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    By Anonymous Anonymous, At February 16, 2013 8:56 pm  

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