Dr fined $100k for not telling patient possible side effects

[Wind30]

There are other cases whereby patient having signed consent form for operation claim that side effects not explained. And that even written consent is not accepted as legally acceptable as long as all patients doubts not answered.

If the thing went well. Sure of course patient has no doubt. If the thing didn't go well. Surely patient has some doubt.

If I tell u ten things, would u remember all ten even ten mins later?

So unless u have a video recording with audio of all consultations, there is no defence currently acceptable.

Just check how many minor side effects, not even talking about major, on any drug or procedure. Ten is nothing.

Gastrointestinal side effects are probably 1/30 side effects for antibiotics. Just the most common.

U can Google any known symptom in medical knowledge and it will be linked to antibiotics.

Giddiness, vomiting, diarrhoea, fever, rash, headache, numbness, double vision, joint pain, muscle pain and on and on and on and on...

Was the doctor fined 100k in those cases? I only know this case which caused the uproar. If u look at the facts of the case, the doctor pleaded guilty, the 100k fine was asked by the doctor. Prosecution was asking for 5 months suspension. I think 100k to him is probably peanuts?

[Jamesc]

I think the most important word here is reasonable.

 

If I was a doctor and a man came to me and said he wanted something enlarged

 

I will tell him I won't do it.

 

He comes to me 10 times and I keep telling him I won't do it.

 

I explain the risk to him and make sure he understand.

 

I get it in writing that he understands the risk of the procedure going wrong

 

and he gets his lawyer to write a letter that he understands and accepts the risk.

 

I would think that I have taken all reasonable steps to make him know and understand

 

the risk. Does anyone have a better idea on what other steps I should have taken?

 

[Jusnel]

I do know of friends who consulted specialists or doc and prescribed medication like steriods, but the damm doc never explain any side effects.

 

It's basic duty of care imposed on the doctor to explain any side effects and ways to mitigate them.

 

We trust our lives with these ppl.

 

And every patient should know to ask the same question to every doc "is there any side effects?"

[Zxcvb]

Can someone copy and paste the straits times article here?

[Fcw75]

Disquiet over a recent disciplinary ruling by a Singapore Medical Council (SMC) tribunal has prompted more than 4,000 people, many of whom are doctors, to sign a petition to Health Minister Gan Kim Yong.

 

The ruling imposed a $100,000 fine on Dr Lim Lian Arn for not telling his patient about possible side effects from a commonly used injection. The side effects usually last one to two days.

 

The petitioners are concerned that the ruling could fundamentally change the way medicine is practised here by imposing a significant additional burden on doctors that will in turn increase the time and cost of treatment. The petition asks that the Health Minister examine the ruling and clarify issues that it has generated.

 

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Their concerns are based on a point raised during Dr Lim's disciplinary hearing: that the "majority of the medical professionals performing these injections do not routinely take or document a detailed informed consent".

 

The petition said: "For every procedure, there are complications that the practitioner, up to now, would have felt were too minor or uncommon to warrant informing the patient.

 

"Every drug prescribed has a long list of potential side effects. A doctor having to go through each and every one of them would take a very long time, especially with patients on many tablets."

 

DIFFICULT TO PRACTISE MEDICINE

 

If every possible complication of a medication or procedure has to be explained to patients, it will be extremely difficult to practise medicine.

 

GASTROENTEROLOGIST DESMOND WAI

The SMC tribunal had found no fault with the treatment, describing it as appropriate.

 

But it said Dr Lim should have informed the patient of possible side effects so she could decide whether to have the jab or not.

 

Dr Lim had pleaded guilty and asked for a $100,000 fine or a three-month suspension. The SMC asked for a five-month suspension.

 

The petition said: "This ruling has grave implications on how medicine is practised. If patients need to be informed of even the most minor or uncommon side effects of treatment, then the cost and time of treatment must necessarily increase."

 

Dr Tho Kam San, an orthopaedic surgeon in private practice who launched the petition on Thursday, said the purpose is not to overturn the judgment but to seek clarity for doctors.

 

He told The Straits Times that if the minister says doctors must tell patients about all possible side effects of all treatments, then they will comply, but it will mean spending a lot more time with each patient. And that will have ramifications for how medicine is practised.

 

Gastroenterologist Desmond Wai had written to The Straits Times Forum pages saying that traditionally, doctors were told to inform patients of serious side effects.

 

"If every possible complication of a medication or procedure has to be explained to patients, it will be extremely difficult to practise medicine," he said, giving the example of paracetamol, which is used so frequently that doctors do not highlight the side effects.

 

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He said "the major and common side effects of paracetamol are mainly drug allergy and liver toxicity, if taken in large quantities. But paracetamol is also associated with more than 20 other potential adverse effects, including insomnia and headaches".

 

Obstetrician Lawrence Ang said: "We filter and reveal what we deem are pertinent. It goes back to our judgment and experience, acquired from our years of clinical practice."

 

A lawyer versed in medical litigation said Dr Lim "might potentially have had a viable defence to the charge against him".

 

Ms Kuah Boon Theng of Legal Clinic LLC said "a doctor is only considered negligent if he failed to disclose information which would be considered relevant and material to the patient".

 

What makes a risk sufficiently material depends on the likelihood and severity of the side effects, she said. The tribunal said the side effects were "limited in nature and extent".

 

But she added: "Having said that, contesting the charges means going through a painful and often protracted process."

[Icedbs]

Can someone highlight what happen to the patient such that this case was brought up to SMC?

 

The news just focus on the fine and repercussion, it didn't mention how come this case was brought up.

 

Did the patient fell into some coma or what after that injection?

[Fcw75]

Can someone highlight what happen to the patient such that this case was brought up to SMC?

 

The news just focus on the fine and repercussion, it didn't mention how come this case was brought up.

 

Did the patient fell into some coma or what after that injection?

The injection was done in 27/10/14 but she only complained to SMC on 11/1/16...dafug?

 

She suddenly woke up in the morning of 11/1/16 and realized that she suffered some pain after the injection more than a year ago?

 

Must be some elite.

[Kopites]

If kena hospitalise one.... every damn thing they do they will ask for consent and sign this sign that... sometime repeated several time....that's fine cause u not going anywhere.... but if in a clinic.... knn.... the fellow need to take 10 kind of medicine.... will take 1 hour, exclude Q&A just to finish talking..... the poor fella outside waiting think already send to A&E

 

Seriously, doctor give medicine.... tell you got this and that side effect, but it's the best medicine to cure the illness.... LL also take.... else how, go see another few doctors or go ask in Forum for advise first???

My GP always start with sharing the cost of med. He always start..It got 3 tiers..1st tier at what cost. 2nd tier at what cost...3rd tier..than he would go on about the dosage. Choice is up to me though.

[Nlatio]

My GP always start with sharing the cost of med. He always start..It got 3 tiers..1st tier at what cost. 2nd tier at what cost...3rd tier..than he would go on about the dosage. Choice is up to me though.

[Icedbs]

The injection was done in 27/10/14 but she only complained to SMC on 11/1/16...dafug?

 

She suddenly woke up in the morning of 11/1/16 and realized that she suffered some pain after the injection more than a year ago?

 

Must be some elite.

 

You are not kidding right?

 

And the SMC entertain that complain?

 

How on earth did they ascertain that after a year, her pain must have came from the injection?

[Kopites]

Wah your complicated.... mine is usually, doctor, can give 3 days MC...

I don't need to ask for MC.

 

Most of the times doc would ask 1 day, 2 days enough?

Edited January 26, 2019 by Kopites

[Kopites]

My stand here is with the doctor.

 

Explaining every side effect and not expecting the patient to pose any question on those side effects? Wow than it would take at least 30min per patient for a normal urti case. Paracetamol, Piriton, cough syrup, lozenges....

 

The fundamental is trust between the GP and patient.

 

The only warning of side effect..might cause drowsiness...that is good enough for me.

Edited January 26, 2019 by Kopites

[Fcw75]

You are not kidding right?

 

And the SMC entertain that complain?

 

How on earth did they ascertain that after a year, her pain must have came from the injection?

No leh, I saw it from the link that bro turboflat4 posted.

 

 

Firstly, there is the patient who complained against Dr Lim Lian Arn. It is interesting how the incident of the H&L injection took place on 27 October 2014 but she only complained against Dr Lim on 11 January 2016, some 14 months later. Especially when she was purportedly unhappy with the adverse effects and complications which are quick to surface and temporary: – pain and inflammation, discolouration, paper-thin skin and loss of fat and muscle tissues. What took her so long to complain?

 

 

That’s why I said she must be some elite. If it were me or some peasant complaining about this to SMC, I am not sure if they will entertain me.

 

But I also saw this from ST, which make me say what?!

 

 

Gastroenterologist Desmond Wai had written to the ST Forum pages saying that traditionally, doctors were told to inform patients of serious side effects.

 

"If every possible complication of a medication or procedure has to be explained to patients, it will be extremely difficult to practise medicine," he said, giving the example of paracetemol, which is used so frequently that doctors don't highlight the side effects.

 

But "the major and common side effects of paracetamol are mainly drug allergy and liver toxicity, if taken in large quantities. But paracetamol is also associated with more than 20 other potential adverse effects, including insomnia and headaches."

 

 

Paracetamol is suppose to be taken for headache but one of the potential side effect is headache?!

 

Damn....learnt something new everyday.

Edited January 26, 2019 by Fcw75

[Wind30]

My stand here is with the doctor.

 

Explaining every side effect and not expecting the patient to pose any question on those side effects? Wow than it would take at least 30min per patient for a normal urti case. Paracetamol, Piriton, cough syrup, lozenges....

 

The fundamental is trust between the GP and patient.

 

The only warning of side effect..might cause drowsiness...that is good enough for me.

[Kopites]

Trust... I donât think there is much trust between doc and patient anymore... look at this episode, just hit them at their purse strings, all the doctors up in arms. Do u see them so on about cutting healthcare costs???

 

That is why I think value based healthcare is the solution..

I an looking more on a personal level of trust between doc and patient.

 

If lack of trust how then can one sit in front of a doc and diligently taking the prescribed med.

[Victor68]

Trust... I don’t think there is much trust between doc and patient anymore... look at this episode, just hit them at their purse strings, all the doctors up in arms. Do u see them so on about cutting healthcare costs???

 

That is why I think value based healthcare is the solution..

I believe if we go this way, SMC can close shop. Doctors are just like any other profession lor.

[Loks]

In my honest opnion....

 

I think this issue is viewed by two different parties. The patients' view and the doctors' view.

About 5600 out of 13000 registered doctors in Singapore have signed online petition regarding this matter. The most important reason why people sign is because of the stiff penalty that is ridiculous. Not only he has to pay 100k (although it may really not be a big sum to him, but this may be a huge amount for a GP or a GP who just started his/her practice), he is threatened to be suspended for 5-6 months.

Yes, doctors have the duty to inform patients on all the potential risks and side effect on every procedure although some milder or rarer issues may not be brought up.

But this matter has worsened previous sentiment on missed Kawasaki Disease by a Paediatrician and she was suspended (KD has incidence of 8 in 100,000 paediatric cases in UK).

 

My thoughts of what most doctors worry of this issue are that:

1. From now on, all procedure (including a simple insulin injection for a diabetic patient) needs to go through thorough explaination (inclusive of those side effects that may occur 1 in 1,000,000) and signed inform consent with presence of witnesses. One medication may have 20 side effects, hence if a patient needs 5....

2. Primary care physicians will unlikely proceed in giving minor injection or simple procedure as there is risk of ligitation despite several years down the road and even risk of suspension despite the so called side effect is temporary.

3. Increase consultation visits and time in specialist clinic. For private specialists, they may need to charge more as their practicing insurance premium will increase if they have signed up for giving steroid injections. For public specialists, they may not be bothered to offer such treatment as they earn peanuts and cannot afford such penalty. After all, there are always some published research article stating are against any treatment.

4. Increase healthcare cost. I guess this is the one that worries healthcare provider most. After the Kawasaki Disease case, most practitioners are less hesitant to order more test and likewise after this incident, most doctors will just be even less hesitant to protect themselves in whichever way possible. An example will be say I see a doctor for bloated tummy for a week. Yeah, maybe it's a reflux or indigestion but I likely to end up have CT scan, scopes, MRI to make sure this is not due to a cancer or something. I will most likely be informed that the bloatedness can be cause by cancer in a 1 in 100,000 chance and hence, it is advisable to get further scan for this.

Just my twe cents...

 

[Wind30]

Sigh... for the last time, the reason why it is 100k fine is because the doctor asked for it.

 

And the doctor did NOTHING ZERO. If the doctor did verbally explain some or even 1 side effect, I think all these hoohaa is justified.

 

It’s beind borderline ridiculous saying this ruling meant every doctor has to explain every side effects of every treatment when it is obviously not the case.

 

But some clarification is probably good, though.

 

May I also know how u know 5600 docs signed the online petition? It could be 5000 bots

Edited January 27, 2019 by Wind30