Over the last week, an interesting chain of events has unfolded with regard to this company called DoctorXDentist (DXD). This is not a new company. It has been around since at least 2018, if not earlier. But it is a unique company. It is a company that purports to be trying to do many things. But as any experienced businessman will tell you, go look at the money trail.
Essentially, it is a company that deals with Search Engine Optimisation (SEO). For doing this, according to The Business Times Report dated 7 Nov 20, (quoting a Tech in Asia report), DXD earns US$150,000 revenue in recurring revenue a month.
This revenue is presumably achieved through selling of “DXD Clinic Solution” packages. Several doctors this hobbit knows have received communication from a person named “Casey” who purports to represent DXD in the selling of such packages.
Examples of these packages:
- Pro 6 package for 6 months costs $9000
- Premium 6 package for 6 months costs $22,000
- Premium 10 package for 10 months costs S38,000
So far so good. This hobbit has nothing against doctors and clinics who want to advertise, as long as they do so ethically and don’t run afoul of the law. And people need to get paid. What the package contains and how much a package costs is a commercial decision between the advertiser and DXD. But as anyone can see, DXD is not exactly an entity that runs on love and fresh air.
The first issue we need to deal with a company like DXD is how is its database constructed and how reliable and up to date it is. DXD claims to be using information lifted from the SMC website – “All Doctor Profiles have been updated from the SMC Directory”. However, the SMC website states:
6. Except as otherwise provided, the Contents of this Web Site shall not be reproduced, republished, uploaded, posted, transmitted or otherwise distributed in any way, without the prior written permission of the Singapore Medical Council.
7. Modification of any of the Contents or use of the Contents for any other purpose will be a violation of the Singapore Medical Council’s copyright and other intellectual property rights. Graphics and images on this Web Site are protected by copyright and may not be reproduced or appropriated in any manner without written permission of the Singapore Medical Council.” https://www.healthprofessionals.gov.sg/smc/terms-of-use
Has DXD gotten permission from SMC to use SMC’s website or directory?
A quick check of the DXD website will make one realise that some of the information is quite out of date and hence not factual. Just a quick check on three doctors using the DXD website by this hobbit today revealed the following:
- A doctor who has changed his place of practice for many months still has the old place of practice listed there
- A doctor who has retired and closed his practice is still listed as practising in his old practice address
- Worse, a doctor who has an interim order served on him by SMC (widely reported in the press) apparently has a clean record with SMC
Non-Manageable Risk to Doctors
The second issue is the risk that directories such as the DXD one may pose to doctors. The issue or risk may be limited if the DXD is just a directory and nothing more. But it is not. It has ratings and comments from patients (Which may be construed to be patient testimonials of sorts), estimation of bill sizes, and appointment-making services.
The SMC Ethical Code and Ethical Guidelines (ECEG) is pretty clear about the issue of advertising of information. Patient testimonials are not allowed.
In Section G5(2) of the ECEG, it is stated, “Even if you have little control over the healthcare organisations, if you participate in events, publications or media content disseminated by the organisations, you must ensure that the information you provide abides by the standards required of medical advertising”.
The Publicity Regulations issued under the PHMC Act is even more specific. These Regulations apply to the licensees of healthcare institutions, including clinics.
Para 12.1 of the “Explanatory Guidance to the Private Hospitals and Medical Clinics (Advertisement) Regulations 2019” issued by MOH; states: “It is the licensee’s responsibility to ensure that the style and content of the HCI’s advertisement, and the manner in which the HCI’s advertisement is published, complies with all relevant provisions of the Advertisement Regulations”.
The takeaway message can be summed up to be – doctors are responsible for the publicity that pertain to us or our clinics (when we are the licensees), even when such information is published by third-party sites and sources. There is simply no escape from this professional responsibility. This is how the regulatory framework is structured. We cannot say “don’t blame me, blame the third-party website”.
DXD: The Special One?
There are several other such SEO companies; e.g. docdoc, doctoranywhere, getdoc, singaporedoc etc, just to name a few. But what sets DXD apart is its insistence that its website must contain practically all registered medical practitioners in Singapore and that even if the doctor wanted to have his/her name removed from the DXD website, it will not do so. It was only on 7 Nov 20 that DXD finally agreed to remove names and information of doctors who have requested to be taken off the DXD website.
With responsibility comes control. What DXD is saying (until 7 Nov 20) is that you, the doctor, does not even have the right to decide whether your name appears on the DXD website, let alone control over other information that is related to you or your practice. In other words, while MOH and SMC says the doctor is responsible, DXD says the doctor has no control. Well, SMC and MOH are backed by the force of law. Laws are enacted by Parliament which in turn is elected by the people. What is DXD backed by?
A doctor who wrote to DXD in early 2020 received this reply from a certain Tristan Hahner, claiming to be co-founder of DXD; he wrote “We are required to list all doctors practicing in Singapore. In other words, our directory has to be complete in order not to mislead patients. We are allowed to display factual information available in the public directory of the Singapore Medical Council without your explicit consent”.
These audacious words of Mr Hahner just takes this hobbit’s breath away. First, he says “We are required…..” without stating who actually requires DXD to do so. Is it MOH? Or SMC? Or maybe a mythological creature (like this hobbit) called Smaug? Or the dwarves of Moria under the Misty Mountains?
Secondly, does DXD really have “patients”? As far as this hobbit concerned, only healthcare institutions such as hospitals, clinics and laboratories have patients; or licensed healthcare professionals like doctors, dentists, nurses, TCM practitioners, and allied health professionals such as physiotherapists, speech therapists etc, have “patients”. DXD is neither a facility nor a professional that treats patients. The fact that DXD claims its potential or actual customers (i.e. users of its portal) as “patients” may be misleading in itself. DXD may or may not end up misleading people, but let’s be honest about it, it doesn’t have any patients. If it had, MOH would have licensed DXD as an institution or as a healthcare professional. Doctors have patients, dentists have patients. This hobbit reiterates – legally and ethically speaking, DXD may have customers, but it has no patients. Get that straight.
The final sentence “We are allowed to display factual information available in the public directory of the Singapore Medical Council without your explicit consent” is the proverbial straw that breaks the camel’s back.
Their justification for not removing the names and particulars of doctors when requested to do so just smells (and it’s doesn’t even smell funny, it just smells). In a blog entry dated 4 Nov 20 addressed to doctors,, the General Manager of DXD, Tyr A Ding, claimed that “We (i.e. DXD) made the decision to include all Doctors after our consultation with MOH Compliance Officers back in 2018” and that “this decision is supported by our legal advisors”.
Now that SMA has counter-proposed to DXD with a meeting with MOH officers around (5 Nov, SMA Website), this hobbit really hopes DXD can produce documented evidence of what MOH “Compliance Officers” had advised them in 2018 as well as the legal opinions of its advisors, should this meeting take place.
The first-line justification for their actions, beyond legal and compliance considerations, can be seen by this sentence “this (practice of listing everybody and not removing anyone) offers an unbiased and comprehensive listing of all available options for our readers to make informed decisions for themselves without any commercial intent on our part”.
Another “wow”. No commercial intent? What about those packages that cost thousands of dollars from “Casey”? Is DXD a registered charity or Institute of Public Character? If you have to pay taxes when you make a profit or surplus, then I will take the “no commercial intent” phrase with a pinch of salt. After all, when the taxman believes you are non-commercial then I will likewise believe. Until then, this hobbit reserves judgment.
But what is more disturbing is that embedded in this sentence is the following idea or ideology:
DXD’s expressed aim (whatever that may be) overrides a doctors’ rights to have freedom of choice to associate or disassociate with an organisation such as DXD. It is interesting to note here that except in emergency or life-threatening situations, a doctor can unilaterally end a doctor-patient relationship (provided he offers and if necessary, makes continuity of care arrangements for the patient). But DXD has decided for doctors that doctors cannot end the DXD-doctor relationship or DXD-doctor association, implying that this DXD-based relationship or association with the doctor is even stronger than the patient-doctor relationship. You can even divorce your spouse, but you cannot get your name removed from DXD (until 7 Nov, that is).
Even in its blog entry on 7 Nov, when DXD announced its decision to remove the names of doctors who have requested so, it stated why it did what it did pre-7 Nov, which was – “In order to make expert health knowledge accessible to all, we need to have a balanced and fair view on how we manage doctors on our site”.
This hobbit asks DXD – who gave you the authority to “manage doctors on our (your) site”? Make no mistake, the word “doctors” here refers to all doctors on the DXD website, and not just doctors who have expressed their desire to work with DXD. Who made DXD the manager of Singapore doctors? Smaug again? The Eye of Sauron? Directors and shareholders of DXD? MOH? Parliament? Donald Trump? Did SMC outsource their work to DXD?
The SMC-DXD Bundle
It would appear to this hobbit that perhaps DXD has a mandate from heaven, to be so powerful as to force or want to foist an association onto practically all doctors in Singapore.
If you think about it, even the Triads and Secret Societies are more reasonable organisations. In the beginning, you have to sign up with them, which in itself is an act of free will. Nowadays Triad bosses don’t put a gun to your head to force you to join them. But once you are in, it’s true that it’s almost impossible to get out unless you go to jail for a long time.
But here, you are in the DXD website even though you didn’t sign up and then you also can’t get out. It sounds like the online version of Hotel California.
Effectively, DXD was saying (pre-7 Nov) that DXD is bundled with SMC. If you are on the SMC Register, you must be on the DXD website as well, just like you can’t delete Siri when you buy and use an iPhone. Awesome isn’t it?
These self-proclaimed rights to “manage doctors”, and to be the offeror of “an unbiased and comprehensive listing of all available options for our readers to make informed decisions for themselves” are so overpowering that they subjugate the basic right of doctors: the freedom to associate or not associate. The freedom to associate or not is really quite a basic right of an individual in a free and democratic society, as SMA had said to DXD on 7 Nov. There are extremely few institutions that can take away that right in Singapore and it is only done so in the rarest of situations, e.g. National Service – all able-bodied Singaporean males have to enlist for and serve National Service. He has no right to non-association with MINDEF, SPF or SCDF (wherever he is posted to for NS). Together, being Singaporean, Male and serving NS is a bundled deal.
Apparently, (until 7 Nov), DXD is another institution that can take away my freedom to associate or not in the form of the SMC-DXD bundled deal.
Finally, this hobbit has one suggestion for DXD. If DXD thinks that its position pre-7 Nov is so right, honourable and great, it should perhaps expand its offerings and activities as well as also apply the same principles and practices to the legal profession – list all the practising lawyers on its website, and refuse to take down the names and particulars of lawyers who request DXD to do so, giving lawyers and Law Society similar reasons that it had given to doctors and SMA. Just replace the word “patient” with “client”. It will be very interesting to see what happens then.