What is the Ministry of Health's Stand on Informed Consent for minor procedures?

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We are highly disturbed that a senior Orthopaedic surgeon was fined $100000 for failing to inform a patient of what was essentially an uncommon and minor side effect of an injection with no lasting adverse physical effects to the patient.

Steroid injections are the most cost-effective first line treatment for many musculoskeletal inflammatory or repetitive strain problems.  These injections are routinely given by many doctors in hospitals, specialist clinics and family medicine clinics. 

The majority of the medical professionals performing these injections do not routinely take or document a detailed informed consent, as stated by the SMC’s own expert witness. It had never been a professional standard of practice to routinely inform patients of minor side effects of medications given for procedures or as prescriptions, especially if they are also uncommon.

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.  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. Healthcare Professionals will have to go through the list of all possible complications from taking blood samples, inserting an intravenous cannula, or administering an intramuscular injection. None of these procedures are currently done with an informed consent as detailed as the Singapore Medical Council’s latest judgment requires, and for good reason. To do so would paralyse a busy accident and emergency unit, ward or clinic.

This is a landmark decision by the SMC. The practice of medicine in Singapore will henceforth be completely legalistic, if all complications and side effects must be told to each and every patient. There is no doubt in our minds that this will drive up health care costs significantly, slow down the delivery of care, and increase waiting times, especially for patients treated in the restructured institutions. This will be to the detriment of all Singaporeans. It is time for the Minister of Health to step in and clarify if this is the direction that healthcare in Singapore should take.

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