Trust between patients and doctors and in the professional disciplinary system is essential for the healthcare system to function effectively.

But these relationships of trust are under "serious threat of erosion", following two high-profile cases brought by the Singapore Medical Council (SMC) against doctors, said a review panel appointed by the Health Ministry.

In a 99-page report released yesterday, the Workgroup to Review the Taking of Informed Consent and SMC Disciplinary Process laid out its recommendations to the Government to restore trust in the system. It said the system has been under strain for some time, adding that there has been "growing disquiet and pessimism within the medical fraternity", even before the recent cases occurred.

As an example, it cited a key legal decision by the Court of Appeal in 2017 that changed the legal test for determining whether a doctor is guilty of medical negligence.

In ruling on a case brought by a businessman against a surgeon, Dr London Lucien Ooi, the court set out a new standard for the taking of informed consent.

It was no longer sufficient for doctors to follow prevailing medical practice standards while disclosing the risks and complications of procedures to patients, the court said.

Instead, doctors must now consider what is relevant to their particular patient at that particular point in time.

Although the new legal standard aimed to be nuanced and well-balanced in promoting patient autonomy, many doctors perceived it as introducing an element of variability and uncertainty in terms of what each patient might want to know, the panel said.

Against this backdrop, the High Court faced two cases in the span of four months this year, which the panel said "should never have been referred to the disciplinary tribunal in the first place".

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In one case, the SMC's tribunal ruled against Dr Lim Lian Arn, an orthopaedic surgeon, and imposed the maximum $100,000 fine for negligence, which was "manifestly excessive", the report said.

In the other case, Dr Soo Shuenn Chiang, a psychiatrist, was fined $50,000 for giving confidential information about a patient to the patient's brother, which the panel said was a "harsh and inexplicable outcome".

Tribunals are made up of doctors and legally trained professionals. They are convened by the SMC and, thereafter, operate independently.

The SMC had brought both cases to the High Court, seeking to review the penalties meted out by the tribunals.

"Some doctors feel the SMC holds them to unrealistically high standards and prosecutes them for minor breaches. There is also a perception that the private law firms the SMC engages are overly focused on obtaining a conviction," the panel said. "This perception was reinforced by the recent court decisions."

The panel said trust between doctors and patients is central to the practice of medicine. The quality of that relationship directly impacts the quality and outcome of care. In turn, doctors must also be able to trust the professional disciplinary system to produce fair and consistent outcomes, it added.

If the system does not effectively and consistently enforce the profession's standards, doctors will be faced with uncertainty and unnecessary stress.

The report said this may cause them to feel pressured to adopt practices they think will best protect them against potential legal liability, even if those practices are less effective in serving the patient's needs.

"Over time, this will erode the trust of the patient, not to mention undermine patient safety," the panel said.

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The SMC's poor handling of complaints will also undermine the public's trust in the medical profession over time, it added.

For these reasons, the review panel recommended to the Government a slew of changes to the SMC disciplinary processes.

The recommendations are intended to ensure the process is made fairer, more consistent and transparent, it said.