Today's ST published a slew of commentaries on 'Greedy' Doctors. We know some, if not most of you, belong or are related to the health sector and we are moved by the overtones and point-blank messages of the commentaries to ask this question: Are doctors in Singapore really ethical?
In two pieces of writing contributed by Singapore Medical Association and College of Family Physicians Singapore, it is said that we should not judge all doctors based on a few black sheep. Dr Chong Yeh Woei, president of the Association pointed out the recent, in fact, longstanding abuse of benzodiazepines, phentermine and Subutex which the authorities should investigate and tighten control of.
Both professional bodies do not condone Ms Salma Khalik's last Wednesday article "Tame doctors' greed and protect patients" and further state, on the forum, reporters should guard against the dangers of unfair reporting and Ms Khalik's commentary tone actually move the public against doctors. Pretty blatant remarks, eh?
All said and done, we would like to ask your opinion on the matter, based on your personal involvement in the profession. It would be most interesting to hear from you.
Tuesday, October 6, 2009
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33 comments:
Whats the diff between Singapore Medical Association and Singapore Medical Council?
I have reproduced the article that the Community Chat has commented as below:
There is no doubt that the majority of the 8,000 doctors in Singapore are ethical professionals. But time and again, black sheep who indiscriminately prescribe drugs for profit and not for their patients’ health rear their ugly heads.
There are greedy people in every profession. But where doctors are concerned, such greedy behaviour can have serious, if not lethal, repercussions.
In the past five years, 23 doctors have been hauled before the Singapore Medical Council (SMC) and penalised for dispensing sleeping pills indiscriminately.
With the influx of foreign doctors, the expanding intakes of the two medical schools and plans for a third, this would be a good time to consider if we should institute more protection for patients from greedy doctors.
The Health Ministry has tried to stop these unethical practices by imposing stiff penalties on the offending doctors. But cases still surface with regularity.
The planned sharing of electronic medical records might put a stop to this. But it will be years before the system covers GPs and not all private doctors would want to be involved.
About the only way to stop the indiscriminate dispensing of pills is to make sure doctors cannot profit from it: by separating prescription from sale.
Unlike medicine such as paracetamol, sleeping pills can be both addictive and dangerous. Taken in greater than normal doses, it can give people a high. Too high a dose can kill.
Addicts have been known to clinic- hop to get their supply of the drug.
Over the past four years, six doctors have been found guilty of freely dispensing Subutex — a medicine that’s meant to help heroin addicts wean off their habit. But the solution to a problem became the problem itself when addicts turned to Subutex as a legal way to get high.
Again, there was a small group of doctors more eager to line their pockets than to help their patients. Addicts desperate for the drug willingly paid the high prices these doctors demanded.
Last week, The Straits Times found several doctors equally lax in prescribing slimming medication.
No one would call reporter Jessica Jaganathan obese. She’s not even plump. She is in fact svelte. Yet, she had no difficulty getting anti-obesity medicine from several GPs. One even offered her a range of pills to choose from.
About 15 clinics here are openly listed on the Internet as easy places from which to get such pills. All five that Jaganathan approached lived up to that reputation.
But that Internet list is obviously not complete, since one in five randomly selected GPs she visited behaved in the same way.
Obesity pills are prescription-only medicine with dangerous side effects, including palpitation of the heart and even convulsions.
One veteran GP said these doctors took the quick and easy way. Convincing a patient that she does not need such medicine takes time, which a busy doctor might be unwilling to give. And obesity medicine is a good source of income since patients tend to return for more.
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These cases are a clear indication that a fair number of doctors here are more concerned with making a fast buck than truly taking care of their patients.
Separating the prescription of medicine from their sale might appear harsh, but it might well be the only way to curb such malpractices. This issue has been debated several times in the past, and on each occasion, doctors have protested vehemently against the proposal since they get a large chunk of their income from selling medicine.
Patients too have argued that it would inconvenience them, especially when they’re sick, to have to go to a pharmacy to buy their medicine.
The separation of prescribing and selling medicine can also be circumvented by doctors setting up their own pharmacy as a separate company, next door to their clinic.
These are all valid arguments. But an exception should be made for certain medicine, such as sleeping pills and obesity drugs.
Patients who need such medicine are not “sick” in the usual meaning of the word. Nor would they normally need the medicine urgently.
Not letting doctors profit from the sale of the drug eliminates the greed factor from a doctor’s diagnosis. A doctor who sets up his own pharmacy to sell such drugs would immediately be suspect.
Further protection can come through registering patients prescribed such drugs, so they cannot over-purchase the medication. This will put a stop to the doctor-hopping that now goes on.
Patients in hospitals would not be inconvenienced since they would have to get their medicine from the pharmacy in any case.
An exception should be made to allow specialists to dispense such drugs, since patients who consult them tend to be suffering from more serious illness.
Conscientious GPs would not generally sell many such medicines, so are unlikely to lose much business as a result.
The ones who will be hit hardest would be the greedy ones who need to be stopped in any case.
But most importantly, such a system would protect patients from overdosing on medicine that could do them much harm. — The Straits Times
http://www.themalaysianinsider.com/index.php/opinion/breaking-views/38957-tame-doctors-greed-and-protect-patients--salma-khalik
Hi Sue, that's a good question. Let myself, a nurse, enlighten you:
Formed in 1959, the Singapore Medical Association (SMA) is the national medical organisation representing the majority of medical practitioners in both the public and private sectors.
The objectives of the SMA are:
to promote the medical and allied sciences in Singapore;
to maintain the honour and interests of the medical profession;
to foster and preserve the unity and aim of purpose of the medical profession as a whole;
to voice its opinion and to acquaint the Government and other relevant bodies with the policies and attitudes of the profession;
to support a higher standard of medical ethics and conduct; to enlighten and direct public opinion on problems of health in Singapore; and
to publish papers, journals and other materials in furtherance of these objectives.
http://www.sma.org.sg/about/
Section 5 of the Medical Registration Act (Cap 174) states that the functions of the SMC are to:
Keep and maintain registers of registered medical practitioners;
Approve or reject applications for medical registration under the MRA or to approve any such application subject to such restrictions as it may think fit;
Issue practising certificates to registered medical practitioners;
Make recommendations to the appropriate authorities on the courses of instructions and examinations leading to the Singapore degree;
Make recommendations to the appropriate authorities for the training and education of registered medical practitioners;
Determine and regulate the conduct and ethics of registered medical practitioners; and
Generally do all such acts and matters and things as are necessary to be carried out under the MRA.
http://www.smc.gov.sg/html/SMC_Aboutus.html
Hope the above helps Sue and the rest of us who may not know about the difference.
We cannot deny that some of the Doctors who enter the profession may not actually follow what the Hippocratic Oath says despite them taking it prior to becoming a Doctor.
Some does it for passion, whilst some do it for fame, still others do it for, simply, the money.
These are the unethical ones mentioned in the article.
I refer to the following extract in the article:
"In the past five years, 23 doctors have been hauled before the Singapore Medical Council (SMC) and penalised for dispensing sleeping pills indiscriminately."
My immediate question would be, how true are these figures and how representative is it on the whole population? In short, how many of these actual cases are reported and how gone unreported?
Ethics may seen hard to embrace and like what the articles says, there are black sheeps everywhere.
I personally feel that and would want to think that most, if not all Doctors are ethically sound to start off with. Theremay be a few black sheeps but we shouldnot let these black sheeps destroy the trust of the social fabric we have in the Medical industry.
Perhaps my take would be to heighted penalties to such unethical and greedy behaviors.
Thanks Ruth, for your kind clarifications!
My sediments for such behavior, mostly exhibited by GPs, are that there is a true lack of regulation and governance, or should I say lack of intervention although there are agencies like the SMA and SMC in place.
Perhaps Singapore has mostly enjoyed a clean record of and a high standard of medical attention, one that has been established on a worldwide scale such that everyone, working on a trust basis, neglects the fact that human greed do sometimes override man-made rules and policies and rules being rule, however well-written, there are always loopholes to be exploited.
Hence, ethics, something that is immeasurable and intangible but yet crucial in face of such a situation would very much come into play.
Perhaps as commented by Mr K.K Lee, there should be heighten scrutiny in this area which has come under the limelight, but having said that, the intervention from external or erected agencies should not cast a pall on the majority of the medical doctors, of whom came into the line of service with patients and passion in mind.
I totally agree with what Mr K.K Lee and Raphael have said. Well said!
Perhaps to add on, proper education for doctors, might be the way to erradicate such unethical behaviors. But how can this kind of education be administered and hence be effective?
There are many ways one can do that, one way is to tag KPIs and incentives to award and reward compliance with ethical behaviors.
There are many measurements indexes which one can employ and look into.
hi there Ruth, great thanks for the info... sorta understd, there are huge overlaps though. cheerios.
sue
Thank you, all. But seriously, what do you think: are doctors in S'pore generally ethical?
Yes/No?
I reckoned there is no way for you to quantify that? What basis and measurements do you establish to use as the standard?
There may be legislatives erected but how about those who acted unethically and yet slip off the gaps of loopholes present and who goes undetected?
Unless there can be a comprehensive assessments, how then can Doctors be labelled ethical or not?
But my take is, in general, Doctors are ethical. Even if I were to err, at least I have faith and trusts in the medical system of Singapore
I agree with K.K Lee that Doctors in Singapore are generally ethical. And not only that, I believed that Doctors, in general, are ethical and has to be ehtical and should be ethical.
In face of temptations and the fact that humans are not perfect, there may be a few blacksheeps who may paint a othwise picture but generally speaking, my take is most of these highly qualified Doctrs, are ethical.
I personally feel that there should not even be talks about whether Doctors are ethical or not. The fact is, didn't we trust these people to treat our diseases and illnesses? And for that matter, the diseases and illnesses of our loved ones? So what if Doctors generally are unethical? Does it mean that we stop visiting them or they will run out of business?
I think to use a chinese proverb to translate what I am trying to bring across, it will be if you use someone, don't doubt; if you have doubts, don't use that someone.
Well Said!
I am doing an evening shift rotation today and will be going to the Hospital later on, and thought I wanted to comment on ethical issues of Doctors.
By now, most of you would know that I am a nurse working in a hospital. I have since many Doctors in actions and I came to the conclusion that most, of not all Doctors in Singapore conduct themselves in a professional and ethical manner, worthy of our praises.
I consider the medical environment of singapore to be very good and I have absolutely no doubts about them.
I think I am 50-50 on whether Singapore Doctors are ethical or not. I would want to think that they are ethical, but perhaps my personal experience with some Doctors have made me think twice about it.
So my take is 50--50
Hi Keith, care to share what you encountered so we can be wary of these doctors?
Thanks in advanced
I will not be able to give you full details here but basically it is a case of exhibitation of unethical behavior by a medical worker. An action which may cross the paths of ethical vs unethical debate.
I do have something to share though. I was rather sick one of the days after work and hence went to the nearest hosital clinic which was just opposite my Office and cost aside, although the consultation and medicine added up to close $100, I was still not well after taking the medication. What's worst is they even recommended me to take bloodtests, etc,which added up to another $100, and in all, I was still not well and hence in one of the nights where the medicine ran out, I went to another neighbourhood clinic and i brought the medication along for verification, and found that those prescribed drugs were not used to treat my illness and that those drugs are normally prescribed for more serious cases (which explains why the drugs are so expensive).
Hence, after this incident, I am rather wary of doctors who dispsense out of the window treatment drugs and recommend me to tdo the many tests which I am not sure if it is really needed or just a case of unethical behavior.
I think some of my friends also conmplained of such plights. Perhaps for such cases, there are really no direct quantifiable ways to assess?
I would say the doctors in Spore are generally ethical. So far has yet to meet any unscrupulous ones.
I've met inexperienced doctors before who gave wrong diagnosis.. but they were not life threatening so I din blow my top. Give them a few more years and I'm sure they will improve.
What's worrying me is the influx of foreign doctors. Some of their spoken english is appalling and makes you wonder their level of competency.
The authorities should let in more young aspiring Sporeans into our local medical school to boost up the number of doctors in future.
If you are talking about professionalism and health, then I think Doctors should make a wrong diagnosis, I think people like Calvin are hard to come by, given the fact that Singaporeans are a complaining bunch of people.
But I do agree on the part about foreign talents influx. I once went to a Polyclinic for a common flu and cold and I was greeted with a 'foreign talent'. I have no qualms about a foreigner being a doctor and for that matter, a foreign doctor treating me, but jus that on a separate note, I don't quite understand what they are talking about and to top things off, just to make sure the doctor got my symptoms right, i repeated whatever I havs said, twice and made the doctor listen and repeat the diagnosis, just to make sure.
You can't blame me for that as after all, it is one's health we are talking about!
So I think perhaps there must be some degree of 'socialization' for these doctors? Imagine a Hokkien-Speaking individual, who may appear educated and English speaking, seeing a Filipino English-speaking Doctor? It will turn out quite a mess, I think.
I share similar views with Calvin and Josh.
On a separate note, however, perhaps bringing these doctors into Singapore might help to stem the talent outflow which Singapore is currently experiencing.
But then again, if the talent outflow poses a problem to the Singapore Medical scene, then why cap the number of students who can read medicine at University level such that even some of the brightest are denied the chance of reading a course of their choice?
I have heard of many students which straight As but still could not get into the Medicine faculty and were forced to seek alternative paths overseas.
Some, after gotton their degrees overseas, because they were so good in their respective fields, were invited back to Singapore to practice medicine, enticed with loads of attractions and compensation.
I just find it weird. JUst a comment.
I have attached 2 articles below for all viewer's references which I thought was very relevant of the topic of discussion.
Just to share:
Doctor suspended and fined over Subutex lapses
A GENERAL practitioner who did not manage his patients properly after prescribing them Subutex has been suspended for three months, fined $2,500 and censured by the Singapore Medical Council (SMC).
http://breaking.sg/story.php?title=doctor-suspended-and-fined-over-subutex-lapses
You can also find the full report at http://www.straitstimes.com/The+Print+Edition/The+Print+Edition_All_20090926.html
Or, from ST Home Page B2, 26th Sept 2009.
Here's another report which I think is relevant:
Two GPs suspended from duties for failing to exercise due care
By Hetty Musfirah Abdul Khamid, Channel NewsAsia | Posted: 16 January 2009 1943 hrs
SINGAPORE: Two general practitioners have been suspended from their duties - just days after the Ministry of Health (MOH) and the Singapore Medical Council (SMC) announced plans to impose harsher penalties on errant doctors under the Medical Registration Act.
In the recent cases, the SMC's disciplinary committee found the two doctors guilty of failing to exercise due care in the management of their patients.
Dr Cheok Soo Teck Harry, a medical practitioner at a clinic in Geylang Road, has been suspended from practice for a period of three months, with effect from December 27, and fined S$2,000.
He faced 20 charges of professional misconduct after the MOH lodged a complaint against him to SMC. The complaint came after MOH officers reviewed 20 patients' medical records related to the prescribing of Dormicum, Erimin, Stilnox and Valium.
Dr Wong Cheng Yiew, who has a clinic located at Woodlands Street, has been suspended from practice for six months and fined S$5,000 due to various aggravating factors.
On one occasion, Dr Wong had prescribed Subutex in combination with another drug named Benzodiazepine to a patient, although it has been known that the combination of these drugs can cause death.
Dr Wong had also continued to prescribe Subutex on two occasions, although the ministry had sent a circular stating that Subutex cannot be dispensed to patients who did not sign up for the Subutex Voluntary Rehabilitation Programme with effect from August 14, 2006.
On top of the fines and suspension, both Dr Cheok and Dr Wong have to bear all costs and expenses of the disciplinary proceedings.
http://www.channelnewsasia.com/stories/singaporelocalnews/view/402923/1/.html
Feel free to share any articles for references if you have found any too.
Another case of unethical behavior from sales of unlicensed drugs, this time from TCM Practitioners:
Bonus Real-life Story
2 TCM practitioners suspended for using, having controlled medicine
The Traditional Chinese Medicine Practitioners Board has suspended the registration of two physicians.
The first is Huang Chunyun of Eu Yan Sang Specialist TCM Centre in Paragon.
A registered TCM physician and registered acupuncturist, Huang gave his patient capsules of medicine which contained substances not meant to be present in Chinese medicines.
The patient went into convulsions after consuming the medicine and had to be hospitalised.
In addition to the patient's complaint, the Health Sciences Authority also confirmed that Huang was charged in court with two counts of contravening Section 5 of the Poisons Act.
This was for selling without a licence capsules containing two poisons - glibenclamide and phenformin.
Huang was convicted and fined $3,000.
The TCM Practitioners Board later conducted a hearing on Huang's conviction, and decided to suspend his registration as a TCM physician and acupuncturist for two years, with effect from 21 March 2006.
In a media statement, Eu Yan Sang says the product distributed by Huang is not a product of Eu Yan Sang.
The company had first suspended Huang in June last year following an inquiry into his conduct.
On 9 January this year, Eu Yan Sang dismissed Huang for distributing a non-Eu Yan Sang product to a client, which was in contravention of the company's internal guidelines.
The second suspended TCM practitioner is Ong Yam Bing of Sheng He Health Products Department Store.
The registered TCM physician had returned from Batam with controlled medicinal products.
Ong was found to have on him 1,000 tablets of Phapros Amoxicillin Kaplet, 1,100 tablets of Pharpros Ampicilin 500 Kaplet, and 400 tablets of Primolut N containing Norethisterone.
He was prosecuted by the Health Sciences Authority under the Poisons Act, convicted, and fined $5,000.
The TCM Practitioners Board has suspended Ong's registration as a TCM physician for six months with effect from 21 July 2006. - CNA/ir
http://angrydr.blogspot.com/2006/08/two-tcm-practitioners-suspended.html
Found this article on Foreign Doctors in Singapore, relevant to our discussions on Foreign Influx of Doctors:
Doctors from abroad form growing pool in Singapore
By Salma Khalik, Health Correspondent
MORE foreign-trained doctors are choosing to work in Singapore as hospitals step up recruitment to cope with the growing health-care demands of an ageing population.
In the past three years, more than half of new doctors here have come from overseas, including 1,000 foreign-trained doctors who have returned to Singapore after completing their studies.
Some hospitals are also recruiting overseas. KK Women's and Children's Hospital (KKH), for example, has hired 15 doctors through six recruitment exercises in Britain, Malaysia, Australia and the Philippines since 2007.
Alexandra Hospital does two overseas recruitments a year. Other hospitals too have been scouring the world to bring in good doctors, many of whom are specialists with years of practice in their field.
Foreign doctors are paid the same as Singapore doctors of similar level.
This drive has seen the number of doctors here grow by more than 450 a year for the past two years, more than double the 200-a-year figure over the five preceding years.
Singapore's need for doctors has been spurred by the growing population, the influx of foreign patients seeking treatment and the desire to provide even better service - a need that the current annual output of just over 200 medical graduates from the National University of Singapore is unable to meet.
Prime Minister Lee Hsien Loong alluded to this in his National Day Rally on Sunday night when he spoke of how Singapore is gearing up for an ageing population.
The country is likely to need double the number of doctors it has now, with a further 1,500 hospital beds being added to the current 11,500 as four new hospitals open over the next five years.
To cope with the need for so many more doctors, the Ministry of Health has made several changes to make it easier for hospitals to recruit foreign medical talent.
Mrs Chua Pek Kim, head of human resources at KKH, said 17 of the 40 doctors it recruited last year, and 11 of the 18 this year, were foreigners or foreign-trained Singaporeans.
Such heavy recruitment is expected to continue for some time, as the Health Ministry wants Singapore to double the number of doctors in the country - from one doctor for every two hospital beds, to one doctor per bed.
Mrs Chua said KKH is still actively recruiting specialists, especially in the areas of emergency medicine, neonatology, paediatric surgery, cardiology and anaesthesia.
Of the 1,750 foreign doctors practising here, 70 per cent, or more than 1,200, are in the public sector. Only one in three are specialists, a Health Ministry spokesman told The Straits Times.
But many of the foreigners working here were practising as specialists, and hope to reach that same rank after the obligatory two years working under supervision.
One such is Dr Lekha Gopal, 39, who was a senior ophthalmologist at Chennai's Sankara Nethralaya Eye Hospital. When she joined Alexandra Hospital in December 2007, she did so as a registrar, or specialist trainee, although at a slightly higher salary than what she received in India.
The eye doctor, who got her first degree in Bangalore and her specialist degree from Scotland's University of Edinburgh, said that in spite of the lower rank, she decided to come for the many advantages here, such as the well-equipped hospitals and the opportunity to do research.
She will be applying for full registration when her two years are up in December. If granted, she will be able to work as a consultant.
She and her husband, a researcher at the Singapore National Eye Centre, who have a three-year-old daughter, are thinking of making Singapore their home.
'Life here is more comfortable and there are a lot more activities we can do over the weekends. We're both very happy,' she said.
According to the Singapore Medical Council, the number of specialists in the public sector has gone up by 73 per cent between 2000 and last year. The number will likely shoot up over the next few years as foreign specialists like Dr Lekha complete their two-year stints as registrars.
There are now 3,000 specialists practising here. The biggest increase was in emergency medicine, which more than tripled from 21 in 2000 to 68 last year. This year, another seven joined the ranks.
This article was first published in The Straits Times
http://www.asiaone.com/Health/News/Story/A1Story20090818-161867.html
Have read in the papers today that "Doctors get a sop from MOH" -- Doctors were unhappy when they heard in Jan that legal eagles could preside over their disciplinary hearings. This was meant to raise public confidence that independent adjudicators would hear out patients' claims. Now the doctors' voices have been heard. There will still be senior legal professionals in Singapore Medical Council's (SMC) disciplinary tribunals, but they need not be chairpersons as had been originally mooted in tweaks to legislation -- and therefore they would not exert greater influence over decisions. Read more here: http://www.todayonline.com/Singapore/EDC091021-0000120/Doctors-get-a-sop-from-MOH
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