Medico-Legal Responsibility in Singapore

by Dr Yeo Khee Quan

In line with our ‘Focus’ theme this issue, we present a review of a book on medico-legal issues. To ensure an objective point of view, this review was undertaken by a member of the medical profession.

Medico-Legal Responsibility in Singapore by Dr Yeo Khee Quan is subtitled ‘Changes in a changing medical, legal, social and economic setting’ . This aptly captures what the author attempts to do in this 154-page softcover book.

Dr Yeo, a specialist in private practice, is one of an increasing number of doctors who have obtained degrees unrelated to the medical field; in this case, an LLB (Hons) and an LLM. This book is based on the thesis which he submitted to the National University of Singapore for his LLM degree.

The book is targeted at a diverse audience. Firstly and most obviously, it is intended as a guide for doctors. This includes doctors at all levels of seniority, from the junior House Officer all the way to the Senior Consultant, as well as doctors in a hospital-based or private practice environment.

Dr Yeo, however, also makes points and raises issues that are relevant to lawyers engaged in medico-legal work, as well as administrators of hospitals and managed health organisations (HMOs).

Divided into nine main chapters, the author first discusses medical responsibility in the doctor-patient relationship. The problem of defining when such a relationship is established and when it is terminated are important in determining the physician’s liability when things go wrong. He also touches on the views of the courts with regards to this special relationship, and how these views have changed over the years such that this relationship can no longer be presumed to exist in all litigation cases.

The Bolam controversy is then explained in sufficient detail. He quotes Judicial Commissioner Amarjeet Singh, who reaffirms the continued relevance of the Bolam test in Singapore in a case discussion. The medical responsibilities in a hospital practice as well as training institutes are the subject of the next two chapters, detailing the duty and liability of doctors as well as the hospital/training institute — a must read for all hospital administrators!

The next chapter deals with the medical responsibility of third party payers, a relevant subject in these days of managed healthcare. Tort, vicarious, corporate, monopolistic and coverage liability are all examined, with relevant examples of cases (thankfully, none local as yet) raised and discussed. The development of HMOs, introducing the element of cost control as a factor in medical management, creates the very real fear that patients will not receive the most appropriate or most effective medical treatment, but only the cheapest. Such issues and their impact on the quality of care of patients have not as yet arisen in Singapore.

Another relevant subject is covered in the next chapter, detailing medical responsibility in the application of information technology. The almost ubiquitous personal computer and the explosion in Internet usage has invaded the field of medicine as well. Medical databases already exist in Singapore and the problems of legal ownership of the data, liability in the case of unauthorised access or loss of data integrity, resulting in adverse patient outcomes, are all touched upon.

The book then ends off with chapters on the medical institutes and statutes of relevance in Singapore, a thought-provoking list of suggested reforms and, finally, a short postscript on important changes in the medico-legal scene since the book was originally written.

It is, overall, a comprehensive and well-written book on a topic of such great scope. It is a testament to the speed at which policies and programmes change that several new issues have appeared since the book was published which need to be addressed, including the introduction of Casemix to all restructured hospitals and the division of medical facilities in Singapore into two separate, competing ‘clusters’ .

Dr Yeo quotes many relevant local and foreign cases to illustrate his points. What struck me while reading the book is that many of the issues have not yet developed in Singapore or, if they have, a large number have been settled out of court, with sensitive information withheld by the medical defence societies or hospitals. I would have wished that the relevant people in charge were more forthcoming, as the benefit from the discussion of more cases with a local flavour would surely lead to more informed doctors, resulting in less litigation, less pay outs and less adverse publicity!

My only real criticisms are reserved for how the information is presented in this book. It appears to have been published by the author privately, from the lack of any indication of a publishing house in the pages. The typesetting also leaves something to be desired and would benefit from revamping to make it an easier read.

I would also like to point out that all his Internet references are inaccurate, with unique resource locators (URLs) linked to local files probably on his own computer hard disk at the time of writing, rather than the appropriate addresses on the World Wide Web.

In concluding, I would recommend this book to any health care professional in Singapore as an essential read along with all the other clinical journals and texts that are a more familiar part of our practice. A greater awareness of our responsibilities and liabilities as doctors is essential if we wish to avoid charges of negligence and litigation. I also hope that the author will keep updating the information in subsequent editions so as to keep this unique book current.

Dr Jeffrey Goh
Radiologist
Department of Diagnostic Radiology
Tan Tock Seng Hospital