The Basket Case of Doctorxdentist (DXD)

The dust looks to have settled for now with the DoctorxDentist (DXD) saga.  On 27 Nov 20, Senior Minister of State Dr Koh Poh Koon posted this on his Facebook account:

“Many of my medical colleagues have been troubled by the methods adopted by DoctorXDentist (DxD) to promote doctors who paid for their services. It is also unclear whether some of the patient “reviews” on the DxD website are genuine and consistent with the relevant rules and regulations. Following discussions with the Ministry of Health, Singapore, Singapore Medical Association and Singapore Medical Council, DxD will now remove all doctors and dentists from their website listing unless the doctor or dentist has opted in.

MOH and SMC are continuing to monitor the situation and will make further investigations into the DxD website where appropriate. We will not hesitate to take further action if necessary. We must safeguard the integrity of the profession and protect the interests of patients”.

I hope this will draw to a close to this rather tiresome if not vexing Search Engine Optimisation (SEO) company’s past distasteful practices which they claimed to have discontinued on 22 Nov (as reported on their website). DXD has said it will now adopt an opt-in model where it will only publish names of those doctors and dentists that opt-in to collaborate with them. It stated, “All medical professionals who do not wish to be on the Find A Doctor directory will have their entire profile removed”. On 26 Nov, DXD also said it will remove all patient feedback and ratings.

Now if only DXD adopted this reasonable position from the beginning, then all this gnashing of teeth and clenching of fists would not have been necessary.

Nonetheless, even as DXD has now apparently adopted a new and reasonable position to continue their business, it is instructive to recap what it did in the last few weeks and months to incur so much indignation from the authorities and the medical community.

Let’s now have a short curious case-study of the DXD…..

An overbearing attitude that dismisses a doctor’s rights to non-association with DXD.

It claimed (as stated in the previous post) that its mission overrides a doctor’s rights to non-association. Clearly a preposterous position for a privately-owned company to adopt, given the fact it is not a regulatory authority backed by the force of specific legislation.

Instant “ownself give ownself” mandate to be the patient’s champion

As stated also in the previous post, the co-founder of DXD, a certain Tristan Hahner replied to a doctor with these words earlier in the year, ““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”.

We now know with some certainty after clarifications from MOH, SMC and SMA that no-one required them to list all the doctors. DXD probably “ownself require ownself” and tried to give the impression that they had a “mandate from heaven”, so to speak. Until SMA called their bluff. The misleading party here is indeed DXD, by claiming that they are required to do something when they cannot give any evidence of who this requiring entity is.

Their repeated use of the word “our patients” in their communications is also very disconcerting. It implies that they actually have patients when they don’t. The fact is, when someone or some facility claims to have patients, it means that these persons or entities owe a professional duty of care to these “patients”. But this understanding must be bilateral. This hobbit thinks DXD doesn’t know what they are talking about and it’s all fluff and bluff. After all, does the “patient” even think or agree that DXD owes him a duty of care? Even for a doctor – he can’t just pick someone from the street and declare unilaterally this someone to be his patient and he owes this patient a duty of care unless this someone agrees that “Yes, Dr X is my doctor” and therefore Dr X owes this patient a duty of care.

Misrepresentation of MOH’s position

If there is one raw nerve that civil servants have – it is to be misquoted or misrepresented. DXD’s early statements claim that they have arrived at their position of compulsory inclusion of all doctors and dentists on their DXD directory after consultation with MOH’s compliance officers. With MOH’s clarification to the contrary (MOH website 20 Nov 20), this is obviously untrue.

Refusal to issue an erratum, let alone apologise

To-date, despite MOH’s request for DXD to publish the erratum on 17 Nov, DXD has yet to do so. This gave MOH and SMC no choice but to publish the erratum on their own websites on 20 Nov 20 respectively. Frankly, if I were the Health Minister, I would have thrown the POFMA (POFMA – Protection of Online Falsehoods and Manipulation Act) at DXD in the face of such defiance.

Flip-flopping

DXD can flip their position faster than a prata.

Incident 1:

On 7 Nov, DXD said in Update 4 that it will be “removing all doctors who have requested to be delisted”. But on 14 Nov, it said it will “republish” these delisted names

Then, to add insult to injury, in a Business Times article (20 Nov 20), their General Manager Ms Tyr A Ding was reported to have said, “But after a closed door meeting with representatives from SMA, SMC and MOH, Ms Ding on Sunday told BT that the company has made a determined decision not to delist any private doctors” from its platform”. She was quoted as having said, “This decision is ours alone, and was made on a sound legal basis”.

22 Nov 20, DXD announces it will remove all names that request so. What happened to “determined decision not to delist…” and “This decision is ours alone, and was made on a sound legal basis”? Tsk tsk. Malu Sial.

Incident 2:

On 10 Nov 20, DXD announced that they will be publishing the full minutes of a meeting that was to be held on 13 Nov with MOH and SMA. On 13 Nov, they stated that they have requested for a “closed doors, non-prejudice meeting and will not be publishing meeting minutes”.

Unauthorised Use of SMC Website and Data

SMA announced on their website on 13 Nov 20 that SMC had informed SMA that DXD had not sought permission from SMC for use of SMC data on doctors and SMC had also not given DXD any permission to do so.

Questionable Use of Patient Feedback and Ratings + Lack of Understanding of Regulatory Requirements

On 25 Nov, SMC announced in an advisory that “Medical practitioners should refrain from participating in online SEO platforms that make use of patient feedback and ratings, as these feedback and ratings can be considered to be patient testimonials which are forbidden in G2(7) of the SMC ECEG and G2.3 of the HME”. An advisory with similar content was issued by the Singapore Dental Council. This really reflects on DXD’s failure to understand what are the prevailing professionalism and ethical standards that is imposed by the regulatory body, i.e. SMC on doctors. This is especially galling when you consider the opening paragraph of their post on 22 Nov 20:

“DoctorxDentist loves what we do, which is to partner with medical practitioners to create expert health content and bring free access to health knowledge. It is a mission that our team continues to believe in wholeheartedly”.

The first thing about partnering doctors is not to get doctors intro trouble. Duh?

When you look back at all this, it is easy for anyone to realise why DXD is such a basket case of a company. This hobbit wonders – can DXD ever achieve credibility as a serious player in healthcare with a track record such as this?

Sequence of Events

3 Nov 20

SMA sends an email to all members offering as a free service to its members, to publish a list of members who do not wish to be associated with the DoctorXDentist (DxD) website, so that the public may be informed that the DxD website does not have the support of these SMA members.

4 Nov 20 (DXD Blog)

DXD publishes statement that they “made the decision to include all doctors after our consultation with MOH Compliance Officers back in 2018…. This decision is supported by our lawyers”

7 Nov 20 (DXD Blog)

DXD publishes on its blog under “Update 4”, “we consulted a team of lawyers who abide by Private Hospital and Medical Clinic (PHMC) Guidelines and local regulatory compliance laws. They advised us to automatically list all doctors on our platform using the SMC Directory to retain an unbiased and comprehensive listing for our readers”

DXD mentioned “we would also like to respect the wishes of various bodies pending further discussions. As such, we will be removing all doctors who have requested to be delisted while we arrive at an amicable resolution for both sides”.

10 Nov 20 (DXD Blog)

“DoctorsxDentist will be meeting with SMA and MOH Regulatory officers on the 13th of November 2020 (2-3pm). We will be updating this blog after the meeting with full meeting minutes as well as resolution details.”

13 Nov 20 (DXD Blog)

“DoctorxDentist has requested for a closed doors non-prejudice meeting and will not be publishing meeting minutes”.

13 Nov 20 (SMA update to members)

The SMC has since clarified in a reply to SMA dated 12 Nov 2020 that “SMC has not given permission to DoctorXDentist to use, reproduce or appropriate the comments found on the online Medical Register on the SMC website, and neither has the SMC received any request from DoctorxDentist for permission to extract the data for use on their website. The SMC will be writing to DoctorsxDentist to seek their explanation on the above. In particular, the SMC will be requesting that DoctorxDentist refrains from using information obtained from the SMC’s website”.

14 Nov 20 (Straits Times, Docs up in arms over website listing their profiles, Joyce Teo)

“After a virtual meeting yesterday with representatives from SMA, SMC and the Ministry of Health, DxD said it will republish profiles”

19 Nov 20 (DXD Blog)

DXD publishes Update 7 at 2pm which was removed at 3:20pm. (100 minutes of existence)

20 Nov (Business Times, DoctorxDentist’s headache grows as MOH, medical bodies lean on platform, Olivia Poh and Claudia Chong)

“In a recent clarification on MOH’s website, it came to light that MOH had neither endorsed nor approved the online platform, despite statements on DoctorxDentist’s website that might have given the impression that MOH had”.

“But after a closed door meeting with representatives from SMA, SMC and MOH, Ms Ding on Sunday told BT that the company has made a determined decision not to delist any private doctors” from its platform””

“This decision is ours alone, and was made on a sound legal basis. As a company, we are unable to compromise the quality of our patients’ healthcare journey just because we are told to drop it. This would be in direct contradiction to our belief that healthcare access should be transparent and made available to all”.

22 Nov (DXD Blog)

Announces that it will work on a opt-in model (no erratum)

25 Nov (SMC website)

SMC issues advisory to all doctors not to take part in SEO platforms that have patient feedback and ratings as patient testimonials are forbidden by SMC ECEG and HME. It further stated that “ In particular, medical practitioners should not be paying for such services by purchasing packages from these platforms for the purpose of obtaining patient testimonials, as payment for such packages or services could be considered to be express agreement on the part of medical practitioners to allow patient testimonials to be part of their publicity and medical advertisement activities”.

26 Nov (Various Newspapers)

DXD announces it will remove reviews, feedback and ratings of doctors from its website

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