Meaningless September


September 2016 is not over yet but it has already been a breathtaking month so far. We have seen the arrival of Zika to our shores which has caused much alarm with the number of cases rising from one to 41 over the first 24 hours. The alarm was due more to bad communications than the infectivity of the virus. As investigations have shown, the Zika strain discovered here is the Asian strain and different from the one in South America which has led to microencephaly.

This whole incident may be akin to something like an Italian ‘discovering’ pasta or an Englishman ‘discovering’ tea plants in China. Zika came from Asia just as tea and noodles probably came from China. So there.

The chances of a foetus actually developing microencephaly is also pretty low anywhere outside of South and Central America so far. So seriously folks, we still need to recreate and procreate like Diego, the super-stud Galapagos turtle who has fathered 800 offspring single-pawedly and ensured the survival of his otherwise endangered species Chelonoidis hoodensis. With a total fertility rate of about 1.3, we really need to stand up for Singapore. And of course, do it with a smile.

I had actually wanted to write this month’s column earlier but I had suffered acute backstrain a week ago. But thanks to the timely arrival of the 2016 SMC Ethical Code and Ethical Guidelines (ECEG) as well as the SMC Handbook on Medical Ethics (HME), my acute backstrain has disappeared. This is mainly due to the fact that I had used hardcopies of the two publications (which together number around 220 pages of A4 paper) as weight for back traction over the last two days. Due to the substantial materiality of these two publications, my back muscles have been pulled out of its otherwise spasmodic state. However, I have also developed early symptoms of carpal tunnel syndrome from lugging these publications around. As you can see, the ECEG and HME are ethical, therapeutic and aetiological at the same time.

The requirements of the ECEG and HME now weigh on my brain instead of my spinal cord previously. The common refrain I have heard from many of my fellow doctors is “The ECEG and HME are so long, who is going to read it?”

I have news for you. You may not read it because it is too long, but many lawyers in town are reading it cover to cover accompanied by paroxysmal fits of rapturous joy that are interspersed with episodes of carnal excitement. You see, even though SMC has rightfully pointed out that the HME doesn’t apply to all situations, most situations will still apply. In other words, you will still have to follow the HME almost all the time and you will have the legal burden of explaining and convincing the SMC disciplinary tribunals why the requirements of the HME do not apply in your particular case.

This Hobbit foresees that much time, effort and of course, legal fees will be spent on arguing whether the HME will apply in the context of a particular case. And it will be tougher to argue for why it doesn’t apply than why it does apply. Remember, the ‘default’ mode has to be “it does apply”.

I repeat – Do not be fooled or lulled into complacency, the HME requirements do largely apply to you in most circumstances. If not, they would not have been included in the HME in the first place. And the lawyers will throw the book at you accordingly. From 2017 onwards, with 64 pages of the ECEG and 154 pages of HME, they have a lot more “book” to throw at you legally, literally or physically.

Some of the more interesting recommendations and requirements are discussed below.

You should not be having a meal in a “Michelin three-star” restaurant (Page 150 of HME) when you accept sponsorship to attend an event. The Michelin 3-star restaurant example is quoted literally. But thank goodness there is only one three-star restaurant in Singapore although Joel Robuchon should feel upset that he has been singled out by SMC. So if you happen to be a doctor and are invited by Mr Robuchon to his 3-star eponymous restaurant in Sentosa, you should politely decline. Tell him you prefer the 1-star Waku Ghin at Marina Bay Sands which may actually cost just as much or more. But it’s a one star so SMC may not be so upset. Seriously, you may also want to tell Monsieur Robuchon the truth –  you really prefer Tai Wah Bak Chor Mee to his 3-star haute cuisine. Or maybe the Kasoh Restaurant at the Alumni Association Building which is rated “Bib Gourmand”. It is the only Bib Gourmand (or maybe any Michelin-rated) restaurant in the world located next to a big mortuary. These Michelin reviewers sure dig the kinky stuff….

Another requirement is that you should not have relationships with your patients on social media (page 112 of HME). This poses more problems than not eating at 3-star restaurants with drug and implant reps.  Do I now have to “un-friend” all my patients on Facebook? What if the patient is also my long-lost classmate from primary school whom I have been reacquainted with just 3 months ago when he walked into my clinic for URTI?

And what about the several practicing doctors who are also politicians? Many of their social media followers are also their patients who are also their political supporters. Does Dr JP (aka “The Resusitator”) have to unfriend the Finance Minister? You, as a public figure or politician may not even know or keep track of which of the social media friends (which may number in the thousands) you have made in the past are also your patients.

The HME states that “if patients of their own accord initiate social media contact, you may engage although it is strongly recommended that you do not do so”. This is a very unhelpful statement because “strongly recommended” really means “no”. How you defend yourself in a court of law in the face of the HME’s strong recommendation is something that remains to be seen and tested. “Strongly” comes with legal implications that we doctors may not truly grasp.

Anyway, onto lighter stuff. On Page 131 of the HME, it is stated that “The terms Consultant and Senior Consultant or any variations are meaningless outside of public health institutions or large organisations that employ you where it allows the public and patients to distinguish rank and seniority among large number of doctor employees. In private practice, such terms should generally not be used in your formal designation”.

It was a slow day in the clinic so this Hobbit decided to go to the clinic or practice web pages of the private specialists who sit on the SMC as our esteemed Council Members or on the Working Committee for the review of the ECEG (i.e. the guys who probably drafted this new ECEG and HME).

Guess what? Two of these Council members who were private specialists were described as “Senior Consultant” or “Consultant”. One of those sitting on the Working Committee used the title “Senior Consultant” on the practice website. One GP on the Committee used the word “Consultant Physician” but since he is employed by a rather large private organization I suppose it’s OK.

I like the word “meaningless” used in the new HME on Page 131. But then again, the ECEG and HME will not be in force till 1 Jan 2017. So these SMC Council Members who are private sector specialists using these titles may still be doing so meaningfully now. But as sure as the sun will rise on 1 Jan 2017, if they continue to do so using such designations on their practice websites (which are NOT large private sector organisations, for sure), they will be involving themselves in meaningless activities.

This Hobbit wonders if SMC has ever censured or punished any doctor for doing “meaningless” stuff? Surely SMC Council members must be held to the strictest and highest standards since they approved the new ECEG and HME for promulgation in the first place?

Luckily the new ECEG and HME does not state that digging my nose or plucking my long feet hair is “meaningless”….if not this Hobbit will be in BIG trouble….

To be fair, the old ECEG which has been in force for more than 10 years needed to be updated. Nonetheless, in the zeal to produce something updated, did we have to go to such lengths? Seriously, which profession will inflict on itself more than 200 pages of Ethical Code and Ethical Guidelines as well as a Handbook of Medical Ethics? Not the lawyers, accountants, teachers, dentists, nurses, engineers or architects…

Was it not the wise King Solomon who said “Meaningless! Meaningless!”?. That about sums up what this Hobbit personally feels about some of the stuff in the new ECEG and HME, in addition to the use of the titles Consultant and Senior Consultant in private practice.

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