SINGAPORE (Mar 13): When Wendy (not her real name) suffered from “trigger finger” two years ago, a visit to her general practitioner’s clinic quickly relieved her pain. The doctor administered a Cortisone injection, also known as an H&L injection, which took away the pain within two to three days.

So, when two of her other fingers acted up in January, Wendy headed back to her GP. To her surprise, the doctor referred her to a specialist instead.

Wendy could not get immediate treatment. Eventually, Dr Chua Soo Yong, an orthopaedic surgeon at a clinic in Mount Elizabeth Medical Centre, administered the injection to her.

Wendy’s experience is the unintended consequence of the Singapore Medical Council (SMC) fining Dr Lim Lian Arn $100,000 for not obtaining informed consent before giving the H&L injection.

“Doctors practise defensive medicine because it is not worth their risk and they won't do certain procedures anymore,” says Dr Chua. “Patients have to go see another doctor like a specialist who would generally charge more, and hence waste patients’ time and money.”

The disciplinary tribunal decision was published on Jan 21. By the time Wendy arrived at Dr Chua’s clinic, he had a two-page consent form ready to protect himself from such litigation.

The way Chua sees it, this leads to an inefficient healthcare system.

Dr Lim’s case had the medical fraternity up in arms. They signed a petition that eventually led to the Ministry of Health (MOH) asking SMC to review its fine.

But, before feathers could be smoothened, SMC slapped a fine on another doctor.

National University Hospital psychiatrist Dr Soo Shuenn Chiang was fined $50,000 for issuing a memo to a patient’s brother who called posing as her husband, saying the woman was suicidal.

The hefty fines worry doctors, who feel Dr Lim and Dr Soo were unduly punished for routine procedures and practices.

“We just felt it’s extremely strange that you can place the entire burden on the doctor. He’s not running a private clinic, he’s an employee of the hospital; so, presumably, the call came through the hospital. If you’re finding the doctor responsible, then everyone is as well — whoever took the call, patched it through and physically handed over the memo,” Dr Shanker Pasupathy, a general surgeon, tells The Edge Singapore.

On its part, MOH has said it is “looking into” Dr Soo’s case. But what are the wider implications for the healthcare system, and how does this impact the hoi polloi? Could these rulings be a marker of a trust deficit between doctors and the public?

Look out for the full story in Issue 873 of The Edge Singapore (week of March 18).