By Dominique Loh, Channel NewsAsia Posted: 29 November 2006 2036 hrs
SINGAPORE: Starting next year, patients will have another avenue to seek resolution in a medical negligence case.
The new framework gets patients to talk to their doctors early, so they can settle a case before it goes to trial, which translates to huge savings in legal costs.
The number of medical negligence cases in Singapore is considered relatively small with an average of about eight to nine cases a year. 97 percent of these cases are settled before they go to trial.
In 2003, there was a peak of 20 cases but 94 percent of the cases never went to trial.
Last year, 87 percent of the 11 cases were settled out of court.
In the first ten months of this year, five cases were reported with one settled while the others are still in the early stages.
This has not stopped the courts from pre-empting court cases through this new protocol which starts in January.
Before even going to court, patients or their relatives will be required to talk to their doctors to seek explanations.
This means both parties communicate early so claims are more likely to be settled.
Such a system will also discourage frivolous or cases without merit. Lawyers say such cases could have racked up legal fees in the hundreds of thousands of dollars.
Toh Han Li, Registrar at the Subordinate Courts, says: "What has happened in the University of Michigan healthcare system is that they've instituted a programme to be more open and communicative by giving more information and talking with the patients.
"As a result of this programme, the number of lawsuits dropped by half in one year and there was a great deal of savings in legal costs. The number of lawsuits dropped from 261 in one year to 114 and there was savings of, I think, a few million US dollars as well in legal costs."
Dr Lee Chien Earn, Health Performance Group at the Ministry of Health, says: "I think what it will do is it will help serve as an additional avenue for patients and healthcare institutions, providers and doctors to communicate and to better understand each other's position.
"I think doctors would be supportive of this because it gives them an opportunity to explain their decisions and to explain what has happened. Both parties come from different perspective. It's when you bring them together that they start to understand what the underlying concerns are."
This framework complements existing dispute resolution systems that are already available in Singapore's healthcare institutions. - CNA/so
I will keep my comments brief and to the point as I do not have the luxury of time (I got an exams tomorrow).
Let me say that I am extremely proud to be a member of Singapore’s medical fraternity. Notwithstanding some “black sheep”, I can truthfully say- hand to heart, that our doctors are well-trained and sincere and do try their utmost to help their patients.
My praise is not just accorded to doctors in the private sector but also to government-employed doctors.
However, despite good intentions, the result of any treatment (surgical or not) may not meet the patient’s expectations. Even in the best of hands, complications may not be avoidable.
The new proposed structure is beneficial for our society as it reduces unnecessary lawsuits.
When we go down the route of excessive litigations, the end result would be more expensive medical expenses as we doctors would be forced to practise ”defensive medicine”. I am not ignoring the fact that with the threat of lawsuits, doctors no longer think of themselves as demi-gods not answerable to anyone. They have become more responsive to the needs of patients and give fuller explanations to patients and do get “informed consent” before any procedures) etc.
However my humble opinion (albeit skewed as I am an interested party), is that the net result is healthy (no pun intended).
If the sole aim in my practice is the avoidance of litigation (and hence adverse publicity), I would have to scan every brain ( I mean patient’s brain) that walks into my consultation room complaining of anything remotely connected to the part of the anatomy between the 2 ears.
But seriously, does everyone with a headache or giddiness need an expensive MRI Brain Scan? The answer is “Yes” if you practise in New York or LA.
I am not advocating a cavalier or irresponsible practice of medicine. The doctor-patient relationship which is based on trust and rapport needs the support of our community and society.
Doctors are human too. We empathise with our patients’ financial hardships and hence, I do find myself saying to my patients thus, “ Although your giddiness theoretically can be due to a small vestibular nerve neuroma, which is detectable in its early stage only with an MRI Brain, the chance of this is small (if it is indeed small). ” I do add the caveat that “if you want 100% certainty” ( or in other words- cost is not a concern), I will arrange for the Scan straight away, now, stat, pronto etc.
But, “if you trust me “( or trust that I am trying to help you without spending money unless really required), - not that you don’t trust me if you want to do the MRI Brain anyway, we (patient and I) will find a cure for your ailments in the most common sensical way.
However, if at the end of the day, some sub-optimal outcome occurs, and the patient is not convinced that the “complication from surgery” (or delay in diagnosis) is unavoidable, then let us talk about it. And try to sort out any issues before resorting to any legal process which will cost the whole of society a lot of money. Of course, some lawyers will bring home more bacon for the table but let’s not digress.
I am still trying to grapple with the impact of this new arrangement.
The jury is still out (in our doctors’ tearoom) whether this will make the practice of medicine closer to what good ole’ Hippocrates meant it to be.
The bottomline is:
Docs are humans too. We do try our damnest. Can’t we just talk about it when things don’t work out?
Dr. Huang Shoou Chyuan