http://www.asiaone.com/Health/News/Story/A1Story20090723-156682.html
Tue, Jul 28, 2009
The Straits Times
S'pore-trained docs more lenient on peers' ethics
By: Salma Kahlik
SINGAPORE-TRAINED doctors are more lenient on colleagues who fall down on ethics compared to those who are trained in medical schools abroad.
They are less willing to have their colleagues disciplined or struck off the register even if they have a criminal record. Nor are they likely to tell on colleagues who are tardy or abrasive.
Two Tan Tock Seng Hospital (TTSH) doctors discovered this after posing real-life ethical questions in a survey of 112 final-year trainee doctors. One in four studied abroad.
Associate Professor Tham Kum Ying and Dr Loi Tsuan Hao said in their paper that the responses from doctors trained at the National University of Singapore's (NUS) medical school were 'suggestive of a tacit norm of non-criticism, a conspiracy of tolerance'. Even where errant behaviour was persistent despite intervention and counselling, they were more 'reluctant to escalate and implement disciplinary action' than doctors trained overseas.
The survey came in the wake of the conviction two years ago of a TTSH trainee doctor who had tried to film a female colleague in the shower. Among the questions asked was whether he should be allowed to practise as a doctor.
Fewer than half of the NUS-trained doctors said he should not be allowed to practise, compared to 71 per cent of their foreign-trained counterparts. Furthermore, seven of the doctors trained here found his actions pardonable.
The TTSH doctors published their findings in the current edition of the Annals, a journal of the Academy of Medicine. The topic of professional standards and ethics was also taken up by two others who wrote separate articles in the Singapore Medical Association News. Their beef: the lack of transparency over mistakes made by doctors.
Prof Tham and Dr Loi suggested a review of medical education here as the teaching of professionalism in the NUS medical school and its affiliated teaching hospitals seemed inadequate. Their findings supported claims by two in five NUS-trained doctors that they had not received good grounding in professionalism in their five years of studies and hospital attachments. A third did not find 'adequate role model clinicians exemplifying professionalism'.
In contrast, doctors trained in countries like Australia, Canada, Malaysia, New Zealand and Britain said they were well taught and fully understood what constitutes medical professionalism.
One foreign-trained doctor, who spoke on condition of anonymity, said some doctors here tend to treat the disease, not the patient. 'A senior consultant goes to the bed of a patient, talks to his juniors about what he wants done, without greeting the patient. It's as though she's irrelevant.'
The TTSH doctors also wanted a system to identify and intervene for 'the few students with deficiencies'. The rare student who cannot practise professional medicine should be dismissed, they said.
Asked to comment on the article, Dr Fatimah Lateef, an emergency medicine specialist at the Singapore General Hospital (SGH) and a member of the Government Parliamentary Committee (GPC) for Health, said she was not surprised by the difference in perception between NUS-trained and foreign-trained doctors.
Until recently, there has not been much emphasis on training doctors on professionalism and communication while other medical schools may have started earlier and placed a greater emphasis on these areas, she claimed.
It was only last year that NUS incorporated medical ethics into the curriculum from year one onwards. Previously, it was taught in year four.
Dr Fatimah, who obtained her degree locally, conducts such classes at SGH 'to fill service gaps and profession gaps' but said that few doctors attend unless attendance is compulsory.
But her GPC chairman, Dr Lam Pin Min, also a medical doctor, felt differently, as do senior doctors in the hospitals.
Dr Lam found it alarming that doctors trained at NUS did not think professionalism was well taught, but he noted: 'This does not translate to NUS medical graduates being less professional than their foreign-trained counterparts.'
Associate Professor Pang Weng Sun, chairman of Alexandra Hospital's medical board, also said the types of unprofessional behaviour highlighted in the article were rare. At the highest level, policing of medical conduct and professionalism is done by the Singapore Medical Council (SMC), which details proper behaviour by doctors in a 26-page guide.
Last year, it disciplined 11 doctors, of whom eight were found guilty of inappropriate prescription of drugs. Two other doctors were disciplined for non-medical matters. The council investigates only cases that are brought to its attention.
In its guide, the SMC says the public's high esteem and trust in doctors 'is contingent on the profession maintaining the highest standards of professional practice and conduct'.
3 real cases
THE survey of 112 house officers (HOs) or trainee doctors by two Tan Tock Seng Hospital doctors sought their opinions on three real cases:
# Case 1: An HO was rude and abrasive to colleagues in spite of counselling.
Those who say the Singapore Medical Council (SMC) should not allow him full registration, which allows him to practise independently as a doctor:
NUS graduates: 24%
Foreign graduates: 71%
# Case 2: An HO persistently did not complete her tasks despite reminders and falsified records. She claimed relationship problems.
No disciplinary action was taken and she was allowed to continue her hospital rotation.
Those who say her next head of department should be told:
NUS graduates: 52%
Foreign graduates: 86%
# Case 3: An HO was caught trying to record a video of a colleague in the shower.
He claimed work stress and loneliness. He was dismissed from the job and served two weeks in jail.
Those who said the SMC should not let the HO continue as a doctor:
NUS graduates: 46%
Foreign graduates: 71%
NOTE: Significantly more women HOs felt he should not be allowed full registration.
This article was first published in The Straits Times.
Tue, Jul 28, 2009
The Straits Times
S'pore-trained docs more lenient on peers' ethics
By: Salma Kahlik
SINGAPORE-TRAINED doctors are more lenient on colleagues who fall down on ethics compared to those who are trained in medical schools abroad.
They are less willing to have their colleagues disciplined or struck off the register even if they have a criminal record. Nor are they likely to tell on colleagues who are tardy or abrasive.
Two Tan Tock Seng Hospital (TTSH) doctors discovered this after posing real-life ethical questions in a survey of 112 final-year trainee doctors. One in four studied abroad.
Associate Professor Tham Kum Ying and Dr Loi Tsuan Hao said in their paper that the responses from doctors trained at the National University of Singapore's (NUS) medical school were 'suggestive of a tacit norm of non-criticism, a conspiracy of tolerance'. Even where errant behaviour was persistent despite intervention and counselling, they were more 'reluctant to escalate and implement disciplinary action' than doctors trained overseas.
The survey came in the wake of the conviction two years ago of a TTSH trainee doctor who had tried to film a female colleague in the shower. Among the questions asked was whether he should be allowed to practise as a doctor.
Fewer than half of the NUS-trained doctors said he should not be allowed to practise, compared to 71 per cent of their foreign-trained counterparts. Furthermore, seven of the doctors trained here found his actions pardonable.
The TTSH doctors published their findings in the current edition of the Annals, a journal of the Academy of Medicine. The topic of professional standards and ethics was also taken up by two others who wrote separate articles in the Singapore Medical Association News. Their beef: the lack of transparency over mistakes made by doctors.
Prof Tham and Dr Loi suggested a review of medical education here as the teaching of professionalism in the NUS medical school and its affiliated teaching hospitals seemed inadequate. Their findings supported claims by two in five NUS-trained doctors that they had not received good grounding in professionalism in their five years of studies and hospital attachments. A third did not find 'adequate role model clinicians exemplifying professionalism'.
In contrast, doctors trained in countries like Australia, Canada, Malaysia, New Zealand and Britain said they were well taught and fully understood what constitutes medical professionalism.
One foreign-trained doctor, who spoke on condition of anonymity, said some doctors here tend to treat the disease, not the patient. 'A senior consultant goes to the bed of a patient, talks to his juniors about what he wants done, without greeting the patient. It's as though she's irrelevant.'
The TTSH doctors also wanted a system to identify and intervene for 'the few students with deficiencies'. The rare student who cannot practise professional medicine should be dismissed, they said.
Asked to comment on the article, Dr Fatimah Lateef, an emergency medicine specialist at the Singapore General Hospital (SGH) and a member of the Government Parliamentary Committee (GPC) for Health, said she was not surprised by the difference in perception between NUS-trained and foreign-trained doctors.
Until recently, there has not been much emphasis on training doctors on professionalism and communication while other medical schools may have started earlier and placed a greater emphasis on these areas, she claimed.
It was only last year that NUS incorporated medical ethics into the curriculum from year one onwards. Previously, it was taught in year four.
Dr Fatimah, who obtained her degree locally, conducts such classes at SGH 'to fill service gaps and profession gaps' but said that few doctors attend unless attendance is compulsory.
But her GPC chairman, Dr Lam Pin Min, also a medical doctor, felt differently, as do senior doctors in the hospitals.
Dr Lam found it alarming that doctors trained at NUS did not think professionalism was well taught, but he noted: 'This does not translate to NUS medical graduates being less professional than their foreign-trained counterparts.'
Associate Professor Pang Weng Sun, chairman of Alexandra Hospital's medical board, also said the types of unprofessional behaviour highlighted in the article were rare. At the highest level, policing of medical conduct and professionalism is done by the Singapore Medical Council (SMC), which details proper behaviour by doctors in a 26-page guide.
Last year, it disciplined 11 doctors, of whom eight were found guilty of inappropriate prescription of drugs. Two other doctors were disciplined for non-medical matters. The council investigates only cases that are brought to its attention.
In its guide, the SMC says the public's high esteem and trust in doctors 'is contingent on the profession maintaining the highest standards of professional practice and conduct'.
3 real cases
THE survey of 112 house officers (HOs) or trainee doctors by two Tan Tock Seng Hospital doctors sought their opinions on three real cases:
# Case 1: An HO was rude and abrasive to colleagues in spite of counselling.
Those who say the Singapore Medical Council (SMC) should not allow him full registration, which allows him to practise independently as a doctor:
NUS graduates: 24%
Foreign graduates: 71%
# Case 2: An HO persistently did not complete her tasks despite reminders and falsified records. She claimed relationship problems.
No disciplinary action was taken and she was allowed to continue her hospital rotation.
Those who say her next head of department should be told:
NUS graduates: 52%
Foreign graduates: 86%
# Case 3: An HO was caught trying to record a video of a colleague in the shower.
He claimed work stress and loneliness. He was dismissed from the job and served two weeks in jail.
Those who said the SMC should not let the HO continue as a doctor:
NUS graduates: 46%
Foreign graduates: 71%
NOTE: Significantly more women HOs felt he should not be allowed full registration.
This article was first published in The Straits Times.
