Standards for doctors

On 22^nd May, The Straits Times reported two Singaporean doctors were fined the maximum $10,000 by Singapore Medical Council for offering and performing various treatments which were not generally accepted by the medical profession. Such practices include commencing therapies such as mesotherapy and stem-cell extract facial therapy.

Dr. Low, one of the plaintiffs, was the founder of the Singaporean anesthetic chain, The Sloane Clinic, and a medical doctor herself. The Ministry of Health has already warned her to stop the aforementioned treatments earlier in September, 2007, but the warning was ignored. Hence the Ministry was forced to lodge a complaint to the medical council in November of the same year. Another plaintiff who worked in TLC Lifestyle Practice, Dr. Lee, worked on similar projects. Dr. Low and Dr. Lee were alleged 7 and 6 charges respectively and was censured 3 and 5 eventually.

Both of them were not satisfied and prepared for appeal. Dr. Low argued that those were generally accepted procedures, though the medical council considered that doctors should provide treatments based on clinical evidence instead of general acceptance.

Since both Singapore and Hong Kong have a British heritage of medical and judiciary practices, this case is an excellent precedence for local doctors.

In countries practicing Common Law, juries have to rely on professional opinions to assist in their judgment. Cases of professionals are usually settled in tribunals, where expert witnesses from both sides argue together. Even the cases appealed to High Court have to supplant with expert opinions, the judges rule with a reference to this ‘Standard of Peers’. Unless it contradicts some core social values, the court usually would ‘give a pass’ to the judgment of the tribunal. 

Standard of Peers is the ultimate protection of patient’s interests. Practically, it concerns safety and effectiveness.

In stem cell therapies, so far only Hemacord has been approved by FDA for treating aplastic anemia. Other ‘stem cell therapies’ are market promotions rather than true therapies.

It is obvious that marketing principles differ from medical standard of practice: it is good marketing as long as selling boom, it is not good medical practice if sales does not address safety and effectiveness. Therefore, commercial promotion is always strictly controlled in medical profession. And there is good reason to do so: the outbreak of PAAG disaster in China is a good example of this. Doctors used PAAG as material for breast augmentation, despite the fact that the material itself has not passed safety test in animals. Arguing that ‘generally accepted practice’ is ‘standard of peers’ is a form of logical fallacy.

Marketing is always present in the market, but practices such as promotion that neglect patients’ rights would eventually damage the interests of the industry. The situation is obvious now. As doctors, it is currently the boldest ones who earn the most. As patients, the boldest ones may be dead on the table due to current practices.

I concur with the judgment of Singapore Medical Council. 

Standards for doctors – Medical Tourism

As mentioned in the previous article, medical tourism has great impact on ethical standards of medical practice. How should we judge this new ‘industry’?

From the patient’s point of view, after investing for treatments (diagnosis, surgeries and medication), a comprehensive holistic care is expected. However, medical tourism usually fall short of post-treatment follow up care. Therefore, patients have the rights to ask for a lower price for ‘incomplete’ care, as a form of upfront compensation. The real situation is, all medical tourism charge overseas patients for more dear prices, why is that the case?

Doctors and medical institutions are aware of the risk of medical tourism: that this practice is deprived of post-treatment care. Complication and dissatisfaction will blow out in patient’s homeland instead of been managed ad locum. In today’s information age, any negative feed-back would be devastating to a physician. Besides, international medical negligence law suits would be costly if not possible. As a result, the supply to medical tourism becomes divided:

Some doctors choose not to serve medical tourists, while some are willing to do so, and some are obliged to work under employment contract of a HMO. The end result is discrepancy between demand and supply, and finally there are the expensive fees.

Anyone with marketing sense would say that imbalance in demand and supply is an opportunity for the market, so increasing the supply of doctors and institutions in the market would solve the problem. However, marketing mechanism is not the solution for medical tourism according to the reason mentioned above. Even the market is able to provide medical services with lower price; medical tourism is still incomplete in its essence, as post-treatment care is still absent. Medical tourism is a castrated medical service.