News - COVID-19: Leading the Good Fight - Singapore Medical Association
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
news
VO L . 5 3 N O . 1 | JA N UA RY 2 0 2 1 | M C I ( P ) 078 / 1 2 / 2 0 2 0
COVID-19: Leading A Closer Look at
the Good Fight COVID-19 Vaccines
news
CON T E N T S
Vol. 53 No. 1 2021
Editorial
04 The Editor’s Musings
Dr Tina Tan
EDITORIAL
BOARD
Editor
Dr Tina Tan
Feature
05 COVID-19: Leading the Good Fight
Deputy Editor
Dr Ganesh Kudva
Dr Chie Zhi Ying
Editorial Advisors
A/Prof Daniel Fung
A/Prof Cuthbert Teo
President's Forum
Dr Toh Han Chong 08 A New Year, A New Hope
Dr Tan Yia Swam
Members
Dr Ganesh Kudva
Dr Lim Ing Haan
Dr Jipson Quah Council News
Dr Tan Tze Lee 11 Highlights from the
Dr Jimmy Teo
Honorary Secretary 16 A Closer Look at
Dr Alex Wong
Dr Ng Chew Lip COVID-19 Vaccines
EX-OFFICIOS Dr Leong Hoe Nam
Dr Tan Yia Swam 12 Healthcare Humanity Awards:
Dr Ng Chew Lip
Celebrating the Winners 18 Medicine and the Law: New
EDITORIAL Dr Tina Tan Section 37 on Standard of Care
OFFICE for Medical Advice
Senior Manager Mr Eric Tin and Dr Alex Cheng Wei Ray
Sarah Lim Insight
Assistant Manager 14 Combating the COVID-19 Threat
Sylvia Thay Prof Leo Yee Sin and Opinion
Adj A/Prof Matthias Paul Toh 22 Clinical Care Lessons: Making of
Editorial Executive
Daryl Lai the Mobile Swab Station
Dr Ivan Low
ADVERTISING AND
PARTNERSHIP
Li Li Loy 24 Combating a Viral Stigma
Tel: (65) 6540 9174 Dr Deborah Ng
Allan Kuek
Tel: (65) 6540 9175
Email: adv@sma.org.sg Doctors in Training
PUBLISHER 26 COVID-19: Reflections on the Cusp
Singapore Medical Association of Clinical Years
2985 Jalan Bukit Merah Cheong Yu Qian, Nicole Yong and
#02-2C, SMF Building Woon Chang Yi
Singapore 159457
Tel: (65) 6223 1264
Fax: (65) 6252 9693
Email: news@sma.org.sg AIC Says
URL: https://www.sma.org.sg 28 Protecting Seniors Against
UEN No.: S61SS0168E
Influenza and Pneumococcal
DESIGN AGENCY Disease
Oxygen Studio Designs Pte Ltd
Agency for Integrated Care
PRINTER
Sun Rise Printing &
Supplies Pte Ltd Indulge
30 Tourism in Our Own Backyard
Dr Chie Zhi Ying
Opinions expressed in SMA News reflect the
views of the individual authors, and do not
necessarily represent those of the editorial
board of SMA News or the Singapore Medical
Association (SMA), unless this is clearly
specified. SMA does not, and cannot, accept
any responsibility for the veracity, accuracy or
completeness of any statement, opinion or
advice contained in the text or advertisements
published in SMA News. Advertisements of
products and services that appear in SMA News
do not imply endorsement for the products
and services by SMA. All material appearing
in SMA News may not be reproduced on any
platform including electronic or in print, or
transmitted by any means, in whole or in part,
without the prior written permission of the
Editor of SMA News. Requests for reproduction
should be directed to the SMA News editorial
office. Written permission must also be
obtained before any part of SMA News is stored
in any retrieval system of any nature.
editorial
Dr Tina Tan
one-year milestone since the first own personal critique that “things
COVID-19 case hit our shores and could have been done better”, it is
Editor turned our world upside down. How extremely hard to argue that any of
much our world has changed! It is us could have done better with the
Dr Tan is a psychiatrist with the hence a good opportunity to look mammoth undertaking of bringing
Better Life Psychological Medicine back on 2020 and ask: “What has this the virus under control, especially
Clinic, and a visiting consultant at the year-long battle against the pandemic under the same circumstances.
Institute of Mental Health. She is also taught us? And how can we use these This issue also features Dr Ivan
an alumnus of Duke-NUS Medical lessons moving forward?” Low’s experience in designing and
School. Between work and family I’m hoping that by now we implementing the Mobile Swabbing
life, she squeezes time out for her are safely into Phase 3, with Station, which made waves during
favourite pastimes – reading a good vaccines being given based on Singapore’s deluge of infections
(fiction) book and writing. the Government’s prioritisation in the dormitories. In addition, I’m
strategy, though we know how honoured to have Prof Leo Yee
fluid the situation can be. While Sin and Adj A/Prof Matthias Toh’s
I was getting lunch the other day vaccines are game changers, they reflections on COVID-19. Incidentally,
when I heard a pleasant and chirpy aren’t exactly silver bullets, despite did you know that Prof Leo is on the
recording over the mall’s speakers the world spending most of 2020 BBC 100 Women 2020 list, right next to
reminding shoppers to sanitise our holding its breath for them. It’s Michelle Yeoh?
hands, use TraceTogether and keep to also particularly interesting to me Lastly, for those of us who have
safe distancing rules. It felt like I was that the COVID-19 vaccines make had to forego our annual year-end
in one of those sci-fi movies where, use of mRNA technology. In that vacation and are feeling a little bored
to set the scene for audiences, the vein, do read Dr Leong Hoe Nam’s and claustrophobic, do have a read
introduction features announcements commentary on the use of vaccines of Dr Chie Zhi Ying’s “travel” article,
to the population as they went about against COVID-19. where she takes us on an adventure
their daily business (cue eerie post- One of our missions at SMA News is right here in Singapore.
apocalyptic music). I also happened to diligently record as much as we can
to spot a group of Safe Distancing Let us soldier on and face what
about how COVID-19 has impacted 2021 has in store for us. Take care,
Ambassadors getting ready to fan out our lives and changed our practices
through the mall on their “patrols”. everyone.
for the benefit of future generations
This is our present, and likely our to come, just as our predecessors
future for the near-term. All these did for SARS. On that note, we wish
were unheard of one year ago. to acknowledge the Ministry of
By the time this issue is out, and Health for their efforts in this time of
in the hands (or devices) of readers, national (and international) crisis. No
Singapore would have crossed the matter our political differences, or our
04 JAN 2021 SMA News
COVID-19:
Leading the
FEATURE
Good Fight
Text by Dr Ganesh Kudva, Editorial Board Member
Photos by Gov.sg, MINDEF, Changi General Hospital, National Healthcare Group,
National University Health System, Sengkang Community Hospital and Singapore General Hospital
The text is concise but clear – the case respiratory symptoms under the Swab Perhaps the greatest testament to
tally for the day, followed by a breakdown and Send Home scheme. This readily MOH’s efforts in fighting COVID-19 is
according to the source of infection, and accessible and aggressive testing where Singapore is now. The battle
a rare instance when a nil return is greatly strategy allowed for cases to be picked is far from over, but as it stands, our
welcomed. This clear and factual text is up and isolated, and thus mitigated case numbers are low, and community
an embodiment of Singapore’s strategy viral spread. MOH’s intensive contact spread is minimal. We are now on
in fighting the menace of COVID-19, an tracing policy also won it many global the cusp of a national vaccination
effort which has been led by the Ministry plaudits. As February turned to March, programme, with vaccinations slated
of Health (MOH). to be provided to all Singaporeans free
Singapore seemed to have turned the
of charge. While many societies have
One of the first countries outside of corner in its pandemic fight.
spoken of virus containment and herd
China to have been hit, Singapore has However, COVID-19 is an insidious immunity, Singapore has instead aimed
been imperilled by this contagion since thing, and before long, the virus began for total viral elimination, and the fact
end-January 2020. There was much spreading within densely populated that this remains very much a possibility
anxiety early on, but MOH’s efforts to foreign worker dormitories. With speaks volumes of the impressive
ensure clear lines of communication hundreds of cases being charted each efforts made by Singaporeans, and its
to healthcare professionals and to the day, it was a truly trying time for the leader – the Ministry of Health, during
broader public ensured that accurate country. What followed next was an this healthcare crisis.
information was made readily available, impressive coordinated effort to stem
and fake news and hyperbole were kept
the spread of the virus – by having even Dr Ganesh is an associate consultant at the
at bay. The escalation of the Disease Institute of Mental Health. He is passionate
more aggressive testing, sequestering
Outbreak Response System Condition about mental health and public policy. In
those who had been exposed or his free time, he avidly follows his favourite
to Orange in February, after community
who tested positive, treating the ill team, Liverpool FC, and travels when he can.
spread was detected, was in step with
in secure facilities, and introducing Each country he visits makes him realise how
measures to channel more resources
whole-country efforts to check any viral alike we all are to each other and how much
into the fight to contain the virus’ spread more united mankind should be.
spread. There was also a requisitioning
and to allow for greater protection of
of public facilities and healthcare
vulnerable groups.
staff to manage the thousands who
Simultaneously, testing capabilities were ill. With these intensive efforts,
were ramped up. Certain Public Health culminating in the two-month long
Preparedness Clinics and GPs allowed circuit breaker, Singapore was able to
for testing of those with acute bring the virus under control.
JAN 2021 SMA News 05
^ KTPH staff contact tracing
^ SAF personnel packing masks
< SAF personnel loading up vans
with packed masks to be delivered to
community centres and clubs
^ The community isolation facility at the Singapore Expo
can house up to 1,800 patients
< SAF Medical Corps personnel ^ v NUHS personnel setting up Big Box community care facility
sanitising their equipment outside
the community isolation facility at
the Singapore Expo
^ NHG personnel donning
2020
personal protective equipment
for dorm operations
JAN FEB MAR
23 First confirmed case. MOH started 1 Mask Go Where launched 4 Duke-NUS and Arcturus Therapeutics
contact tracing partner to develop COVID-19 vaccine
4 First COVID-19 cluster identified at
Gov.sg WhatsApp started Yong Thai Hang Medical Hall 13 Additional precautionary measures
COVID-19 updates implemented, including travel advisories
7 DORSCON level raised to Orange
and Stay-Home Notices
MOH launched website on
12 Cluster at Seletar Aerospace Heights
COVID-19 Local Situation
construction site identified 17 Singaporean students studying overseas
30 SAF deployed 1,500 NSFs encouraged to return home
for mask packing 14 Activation of PHPCs announced
20 TraceTogether app launched
Flu Go Where launched
21 First 2 deaths reported
25 Serological test establishes link
between clusters 24 D’resort NTUC converted into
isolation facility
28 Special bonus for HCWs working with
COVID-19 patients announced as a 30 Clap for #SGUnited to show appreciation
show of appreciation for front-line HCWs
06 JAN 2021 SMA News
< CGH staff updates the situation
report board on patients unable to
self-isolate while awaiting their swab
test results
> SGH staff performing a swab
^ SKCH nurse clinician conducting N95
mask fittings
^ Woodlands Health Campus staff serve at the
community care facility@Expo
> Exercises with migrant workers at swab
isolation facility
v Prep work to support operations at dormitories v Contact tracing operations at Mandai Hill Camp
APR JUL DEC
5 S11 and Westlite Toh Guan Dormitory 24 Rapid antibody test kit developed by 14 Authorisation granted by HSA for
quarantined due to increasing A*Star and MP Biomedicals Asia Pacific Pfizer-BioNTech vaccine
number of cases
19 MOH started conducting joint
7
14
Circuit breaker began
MOH deployed medical teams from
AUG webinars on Vaccination Strategy with
professional medical bodies
hospitals/polyclinics to all dormitories 21 First batch of vaccines arrived
23 SafeEntry implemented in hotspots,
7 All dormitories completed testing in Singapore
for COVID-19
essential services, selected public venues 28 Phase 3 began
28 6 SAF camps converted into community
recovery facilities began taking NOV 30 Staff from NCID first to be vaccinated
in patients
25 No locally transmitted or dormitory
cases reported for 15 days
JAN 2021 SMA News 07
PRESIDENT'S FORUM
A New Year,
A New hope
Text by Dr Tan Yia Swam
As we welcome 2021, I see the year to 1,000 participants. I urge all doctors to Integrated Shield Plan (IP) has fair and
heralding new hope and new beginnings. stay vigilant in the use of vaccines and adequate coverage.
I’m referring, of course, to the COVID-19 report adverse reactions, if any, as they The SMA Council has also been
vaccines that have been developed arise. This should be done without vaccine increasing our efforts to engage more
and are being administered to various panic, but with reasonable caution as in sectors of our profession. I would like to
populations around the world. In time, the use of any new medication. Each of us highlight some of these efforts and express
this should bring us closer to the world serves as a leader to our community and my thanks and deepest appreciation for
we knew, but perhaps with increased circle of influence, as others look to us for the people involved.
sensitivity and respect for Mother Earth guidance.
and the ecosystem we live in.1 Dr Ng Chew Lip, Dr Benny Loo,
Meanwhile, we must all continue to Dr Lim Kheng Choon and Dr Ivan Low have
practise other basic precautions which reached out to the medical students (local
Our role as community leaders have been shown to be effective: good and overseas) and doctors in training. There
The world suffered together in 2020, hand hygiene, avoiding crowded places were several meetings via Zoom, including
with the global pandemic having and mask-wearing. the setting up of a Telegram network to
unprecedented effects on our economy, modernise our mode of engagement.
healthcare, travel, and even restrictions on Continued engagement
Dr Ng Chee Kwan and Dr Wong Chiang
personal behaviour. The SMA Council has continued to Yin have been instrumental in representing
Where then is the balance between collaborate very closely with our sister the rights and needs of doctors in the
individual rights and autonomy, and the professional bodies – the Academy of private sector.
needs of society and the greater good?2 Medicine, Singapore and College of
Debates arose over the use of masks, Family Physicians Singapore – in matters Dr Lee Pheng Soon, the current
number of people that can gather, need for of professionalism, development and Executive Director of the SMA Centre
vaccination, and access to limited resources COVID-19 support. Together, we have for Medical Ethics and Professionalism,
such as ventilators, test kits and vaccines. also been working closely with MOH on has developed additional courses and
As individuals, it behoves us to remain the management of private healthcare updated existing ones in the development
educated and updated on the information costs, insurance coverage, and third- of ethics training.
and data available to make informed party administrator practices. The Dr Tina Tan and Dr Chie Zhi Ying head
decisions. As professional leaders, we must issues are complex and involve multiple the SMA News and have maintained
engage with various stakeholders, and stakeholders. This is a massive ongoing a great selection of vibrant articles
intelligently discuss the pros and cons of project and I urge everyone to take note and kept us up-to-date with the rapid
the various strategies to achieve maximum and be involved in these discussions. changes in COVID-19-related matters
good for our society. While it might seem like only the over the past year.
The Ministry of Health (MOH) reached private sector is affected, we are all part I am also thankful to the various
out to the professional medical bodies to of the Singapore healthcare system, and Council doctors who further represent
co-host webinars on Singapore’s COVID-19 we need to look after all our patients, be our profession in various committees,3
vaccination strategy. The first session was they “private” or “public”. Not forgetting and all our volunteers who have given
rolled out on 19 December 2020 with SMA. that we will all be patients someday and their time to be involved in SMA’s work
Attendance was overwhelming, with close I, for one, would want to know that my and committees.
08 JAN 2021 SMA News
pressure on doctors
References
that were eventually
1. Schuijers L. COVID-19 is an opportunity to reset
implemented by the
our environmental future. Available at: https://bit.
respective entities. ly/3nFnUAt.
The SMA has also 2. Bayer R. The continuing tensions between
continued to advocate individual rights and public health. Talking point on
for doctors and patients public health versus civil liberties. EMBO Rep 2007;
8(12):1099-103.
in addressing unfair
practices by managed care 3. Singapore Medical Association. Committee
chairpersons and SMA representatives 2020-2021.
#SGArtforHCW companies and third-party Available at: https://bit.ly/2Kr606f.
administrators,11 exclusion
4. Chia GS. Reflections on MOH’s recent salary
Growth and support of coverage for diagnostic endoscopies revision. SMA News 2012; 44(7):28-9.
under some IPs12 and stepped in
I was rather disheartened last December 5. Singapore Medical Association. SARS Outbreak –
when Members complained about
to see the usual group of year-end SMA Acts. SMA News 2003; 35(3):1.
their particulars being listed without
resignations from SMA Membership. 6. Singapore Medical Association. News from SMA
permission on the DoctorxDentist
Whenever this happens, the reasons Council. SMA News 2008; 40(12):12-5.
website.13 The SMA does not only speak
given are similar: “I do not see any point. I 7. Inland Revenue Authority of Singapore. Useful tax
up for the private sector, or younger
do not have any benefits”. I wish Members pointers for medical practitioners. SMA News 2014;
doctors, or a specific group. Ultimately, 46(3):22-4.
would share with us what constitutes
as medical professionals, we all share a
“benefits”, to you. 8. Lim KC. Highlights from the Honorary Secretary.
common goal and a responsibility to our SMA News 2020; 52(2):12.
Members can attend continuing patients, and to honour our profession –
9. Lim KC. Highlights from the Honorary Secretary.
medical education (CME) activities at no For Doctors, For Patients. SMA News 2020; 52(5):10.
cost, and enjoy special rates for classified
In the past year, the COVID-19 support 10. Singapore Medical Association. SMA’s footprint
ads and training for clinic assistants.
that the SMA secretariat and Council has during the COVID-19 Outbreak. Available at: https://
Over the years, our membership provided for our Members (and even bit.ly/3pWtr6z.
team has also sourced for many lifestyle non-members) was immense, considering 11.Singapore Medical Association. Position
perks and discounts from restaurants that we are a non-governmental and Statements/Advisories. Available at: https://bit.
and merchants for our Members. On less ly/2uQEfIO.
non-profit organisation. I am especially
tangible benefits – and really, what being grateful for the many new friends and 12. Ng CL. Highlights from the Honorary Secretary.
the show of support from doctors who SMA News 2020; 52(10):12.
an SMA Member means – the SMA has
championed various causes over the appreciate what we do. Your support 13. Ng CL. Highlights from the Honorary Secretary.
means a lot to me and the Council, as we SMA News 2020; 52(12):10.
years: junior doctors’ remuneration,4
SARS support,5 Guideline on Fees,6 taxes continue to represent you.
for doctors,7 etc. At the beginning of the Friends and Members of the SMA, I
current pandemic, the SMA organised call on your support in the year ahead, Dr Tan is a mother to three
sales of N95 and surgical masks,8 as well as we take on the challenges of tackling kids, wife to a surgeon; a
as a hand sanitiser distribution exercise increasing healthcare costs, adapting to daughter and a daughter-
for Members.9 The SMA also spoke changes in the new disciplinary process in-law. She trained as
up for doctors on CME requirements of the Singapore Medical Council, and
a general surgeon,
and childcare arrangements,10 and and entered private
in the teaching and development of practice just over a year
suggested measures to alleviate professionalism and medical ethics. ago, focusing on breast
surgery. She treasures her
Help us to help you; invite your friends and wishes to have
friends to sign up as Members. The larger more time for her diverse
our representation, the stronger our interests: cooking, eating,
collective voice. music, drawing, writing,
photography and comedy.
Hand sanitiser distribution
sk sales
d su rg ical ma JAN 2021 SMA News 09
N95 a n
council news
From the Honorary Secretary
Report by Dr Ng Chew Lip
SMA-Ministry of Health webinar Dr Ng is an ENT consultant in public
on COVID-19 Vaccine service. After a day of doctoring and
cajoling his two princesses at home to
finish their food, his idea of relaxation is
SMA and the Ministry of Health (MOH) co-organised a watching a drama serial with his lovely
webinar for doctors on 19 December 2020 to update the wife and occasionally throwing some
profession on Singapore’s latest plans for the paint on a canvas.
COVID-19 vaccine.
About 1,000 participants attended the webinar, posing
many thoughtful questions that elicited detailed responses Realignment framework for businesses
from the panellists. The MOH is preparing a Frequently impacted by COVID-19
Asked Questions document on COVID-19 vaccination,
which will be disseminated to doctors soon. Small businesses and individuals who have been
significantly impacted by COVID-19 and need to review
Panellists included: their business models and contractual obligations will
benefit from the Re-Align Framework, which commenced
A/Prof Kenneth Mak on 15 January 2021.
Director of Medical Services, MOH For more details, please refer to the Ministry of Law
website at https://bit.ly/3ppw2pe.
A/Prof Benjamin Ong
Chairman, Expert Committee on
COVID-19 Vaccination
SMJ social media updates and podcasts
The Singapore Medical Journal (SMJ) recently established
Prof Tan Chorh Chuan
a presence on social media platforms, including LinkedIn,
Chief Health Scientist, MOH Facebook and Twitter, to enhance the reach of the works
of scholarship in the journal. A new podcast project has
Dr Wycliffe Wei also been launched, in which authors are invited to share
insights on their published articles in a bite-sized format.
Senior Resident, Communicable So far, five episodes have been produced. The podcasts
Diseases Division, MOH are available at https://www.smj.org.sg/podcasts. We
encourage Members to follow the SMJ on social media,
A/Prof Lim Poh Lian and to stay abreast of the latest research.
Member, Expert Committee on
COVID-19 Vaccination
SMA staff retreat
Dr Tan Yia Swam
President, SMA An online retreat session was organised for the SMA
secretariat on 12 December 2020. Staff present reviewed
the accomplishments over the past three years, and
Adj Prof Tan Sze Wee discussed and set goals for the coming year. The
Council Member, SMA secretariat’s focus remains on serving SMA Members.
Several Council members also joined the retreat to provide
additional feedback and to get to know the staff better.
JAN 2021 SMA News 11council news
Healthcare
Humanity
Awards
CELEBRATING THE WINNERS
Text by Dr Tina Tan
For those of us who worked through the the better. These folks saw something that while humans can’t accomplish
SARS outbreak in 2003, there are often that could be done better, and rather than something as show-stopping and eye-
sad and traumatic memories. Yet, one of complain about it, they sacrificed their catching as the X-Men, the results are
the bright spots from back then was the time and effort to research, strategise and stunning all the same.”
setting up of The Courage Fund, which implement changes. In other words, they
A big congratulations to the award
helped support those affected by SARS. were the change they wanted to be.
winners, and to their predecessors
An offshoot of The Courage Fund’s legacy I’ll admit I’m not much of a change- who enabled these awards to come
is the Healthcare Humanity Awards. maker. But stories like those of the award into existence.
These awards are given out to those in winners’ inspire me to continue the daily
the healthcare profession who stand grind of my work, knowing that in every
out because of their dedication and the setting, there is someone out there going
values they impart through their work. against the flow (or perhaps just kicking
Incidentally, for those who may have Dr Tan is a psychiatrist with
up some turbulence), for the betterment
the Better Life Psychological
missed it, SMA News interviewed former of our patients and society as a whole. Medicine Clinic, and a visiting
SMA President Prof Low Cheng Hock consultant at the Institute of
This theme will be especially relevant
earlier this year, where he talked about Mental Health. She is also an
this year, when times are challenging
his involvement with The Courage Fund alumnus of Duke-NUS Medical
for everyone involved. Each year’s School. Between work and
(https://bit.ly/5208-Feature).
winners were selected from nominations family life, she squeezes time
Fast forward 17 years to 2020 and the submitted the year before. Can you out for her favourite pastimes –
COVID-19 pandemic, I was privileged to imagine the stories we’ll get to hear from reading a good (fiction) book
attend the Healthcare Humanity Awards this year’s winners? I am sincerely looking and writing.
ceremony on 8 December on behalf of forward to that.
SMA. In usual fashion, it was held virtually “I wish I had superpowers,” said my
due to COVID-19-related restrictions. eldest, after we had watched part of
Despite the virtual awards ceremony not X-Men: First Class together. How would
being quite the same as a live show, I found you respond if your kids made the
myself drawn to the featured stories of same comment?
the award winners. Some of the doctor
I shan’t reveal my off-the-cuff answer
recipients included Dr Jamie Phang,
(because I honestly don’t remember
Dr Joanna Chan, Dr Dennis Chia and
what it was). But here is what my ideal,
Prof Lim Poh Lian. mummy-scores-points answer would
There is a common theme running have been: “Humans can do a lot of
through their stories: a drive to benefit remarkable and amazing things when
patients by changing the status quo for challenged. Perhaps the difference is
12 JAN 2021 SMA NewsINSIGHT
COMBATING THE
COVID-19
THREAT
Text by Prof Leo Yee Sin and Adj A/Prof Matthias Paul Toh
At the time of writing, Singapore has mild and recovering COVID-19 patients. tracing, testing and isolation. To sum it
been battling with SARS-CoV-2, the This meant that we could preserve up, community efforts plus the political
aetiologic agent of COVID-19, for precious hospital resources for the more will to keep the virus under check has
almost 11 months. What is Singapore’s serious cases that might require oxygen brought us to where we are today.
scorecard on the global scale? Could supplementation and intensive care.
we have done anything differently? In an
Third, Singapore adopted the The difference between SARS
earlier article published in SMC News, Prof
whole-of-healthcare and whole-of- and COVID-19
Leo reflected on COVID-19 in Singapore
government response. With foresight, Would SARS-CoV-2 be eradicated
and highlighted several key elements
the Multi-Ministry Task Force was set like SARS was in 2003? Despite both
that placed our nation in its current
up before Singapore received its first being zoonotic coronaviruses, there
state of low community transmission
imported case to direct the national are several major differences that
and modest mortality rate.
whole-of-government response to make eradication highly unlikely. In
This article revisits some of the key the COVID-19 outbreak. This allowed 2003, SARS rarely showed up without
elements in disease prevention and high-level decision-making with symptoms and the virus replicated
control in Singapore during the past year. coordinated and consistent messaging in the lower respiratory tract with
and implementation of public policies. increased infectivity during the second
Singapore’s effective response Fourth, the establishment of a
week of illness or pneumonia phase.
Fever, a symptom easily recognised
First, owing to past experiences with collaborative research platform with
at the onset of illness, provided easy
SARS and other infectious disease central coordination from the NCID.
identification of close contacts for
outbreaks, Singapore was in a state of Patient samples supported viral
quick isolation. Healthcare workers
readiness before COVID-19 hit our shores isolation and the development of a
faced a high risk of infection which
and fortuitously, the new state-of-the-art local serology test kit that detects
was mitigated by appropriate personal
National Centre for Infectious Diseases neutralising antibodies – the first
protective equipment. In 2020, this
(NCID) building had been officially of its kind to be licensed by the
novel SARS-CoV-2 behaves very
opened for four months. US Food and Drug Administration.
differently. Viral transmission occurs
Second, the healthcare system was Having a longitudinal research cohort
early during the pre-symptomatic
flexible enough to respond swiftly allowed disease characterisation and phase and asymptomatic cases have
to the unprecedented challenges discovery of viral shedding patterns been reported to be approximately
of COVID-19 that spread with light- to provide evidence-based preventive 20% to 40%, or higher. Often, these
ning speed, reaching a peak of measures. Participation in international transmissions occur in the community,
1,426 incident cases on 20 April therapeutic trials gave access to new particularly among households where
2020. The Singapore Expo and other antiviral and therapeutic agents. safe distancing and universal masking
large facilities were repurposed as Last but not least, a robust public are difficult to adhere to. All odds stack
Community Care Facilities for managing health system in surveillance, contact up against eradicating SARS-CoV-2.
14 JAN 2021 SMA NewsThe journey continues and South America confirmed that presents unexpectedly with dire
reinfection is an entity to watch out for. consequences. Once again, COVID-19
Eleven months into the COVID-19
However, the true incidence and disease has taught us, loudly and clearly, that
battle, Singapore has managed to
severity remain largely uncertain, given to win the battle we need a well-
maintain a low level of fewer than
that SARS-CoV-2 is likely to stay with coordinated and whole-of-healthcare
20 daily new cases for more than
possible repeated recurrences. response, not by infectious diseases
ten weeks, of which most were
In a short period after the alone as a medical discipline or restricted
imported. As of 1 December 2020,
emergence of SARS-CoV-2, three to one institution or healthcare cluster.
there were 31 cases in community
We need to venture beyond Singapore’s
care facilities and 29 in acute care vaccine developers published near
shores, to be well-connected within
settings with the majority in NCID. perfect efficacy reports of over 90%.
the region and internationally for
Healthcare is progressively returning Two of these utilise new technology
self-defence against invisible invading
to pre-COVID-19 levels. However, using mRNA to elicit humoral and
microbes. Only as a united human race
this is nowhere near the end of the cellular immunity and the third is a
will we have the chance of winning
COVID-19 pandemic. Cases continue platform vaccine technology using
against the invisible microbes.
to soar in many parts of the world. The a chimpanzee adenovirus to deliver
US reported cumulative 13,920,038 virus materials. Although none of
cases, including 274,332 deaths as of 1 these have been published in medical
December 2020. Resurgences are also journals, the eagerness of the global Prof Leo is an adult infectious
experienced in Asia involving countries community to implement large-scale disease specialist. She has led her
team through multiple outbreaks
that had done well to control COVID- vaccination programmes is palpable,
in Singapore. Most recently she has
19 earlier in the year, including South particularly under the immense successfully managed Singapore’s
Korea, Japan and Hong Kong. pressure of COVID-19. A successful first imported case of the monkeypox
vaccine may be the ultimate game in May 2019 and is currently leading
Singapore, like many other countries, her team at the National Centre for
changer but it is unlikely to bring us
is eager to open our economy and Infectious Diseases in managing the
back to the pre-COVID-19 era, as the
boost international trade and ongoing COVID-19 pandemic.
effectiveness of the vaccine is yet to
tourism. A risk-based approach has
be studied. Although it appears safe
been taken, and close surveillance
immediately post-vaccination in about
and monitoring are needed, along
200,000 trial recipients, mechanisms
with the agility to adjust restrictive
to systematically monitor longer term
preventive measures. Singapore has
safety remain a critical component.
2,295 cumulative community cases
detected as of 1 December 2020. The Given that SARS-CoV-2 is likely
seroprevalence studies in Singapore to be present in the long-term and
suggested an extremely low prevalence possibly have repeated occurrences
in the human population, its longer Adj A/Prof Toh has a special interest
(below 1%) that supported the limited
in disease prevention and control,
community transmission observed, but term trajectory and viral evolution health promotion and primary care.
more importantly pointed to a large akin to the influenza virus will need to At the National Centre for Infectious
population susceptible to COVID-19. be included in the respiratory illness Diseases, he coordinates public
There is no room for complacency in surveillance system. 2020 also saw health operations for contact tracing
a dual epidemic of COVID-19 and and leads the epidemiology team to
sustaining preventive measures and
provide insights on the global and
keeping the system ready to handle dengue. At its current state, NCID has local situation for communicable
potential surges of cases. fully deployed its inherent human diseases, and is actively doing so
resources, thus the beefing up of surge during this COVID-19 pandemic.
Human coronaviruses are known to
capacity and capability is of urgent and
have short-lasting immunity, leading
paramount importance.
to reinfection. In August, Hong Kong
published the first case of a returning
resident who was infected by two Final thoughts
different strains of SARS-CoV-2 four A novel infectious disease of public
months apart. Several subsequent health importance does not respect
reinfection cases reported in Europe geographical boundaries and often
JAN 2021 SMA News 15INSIGHT
A Closer Look at
COVID-19
Vaccines Text by Dr Leong Hoe Nam
Vaccines have only been second to Harnessing new technology: Median onset was day two and three,
water in saving lives. They successfully mRNA vaccines with median duration of one day.
eradicated wild-type smallpox, Significant adverse events reported
Pfizer-BioNTech’s mRNA COVID-19 vaccine
leaving only remnants in two secured include lymphadenopathy (0.3%)
(BNT162b2) requires a cold chain of -70
laboratories in the world. Can a vaccine degrees Celsius during transport. At -20 and Bell’s palsy (two patients out of
overcome the COVID-19 pandemic that degrees Celsius, the vaccine is stable for 20,000 subjects), which occurred three
has killed more than 1.7 million people? two weeks. In a typical clinic’s refrigerator and nine days after the second dose
Despite the unprecedented colossal of 2 to 8 degrees Celsius, it may be stored and with resolution of symptoms.
research in this new evolving disease, we for 120 hours (five days). Each multi-dose Thirteen hypersensitivity reactions
expect only more questions, doubts and vial holds five doses, with possible extra were reported versus six in placebo.
perhaps dismay. doses (a sixth or seventh dose) in some The literature suggests that this
In a world’s first, we have two mRNA vials. Vaccines must be reconstituted in was due to polyethylene glycol. The
vaccines approved by the US Food sterile normal saline. Each dose is 0.3 ml media has reported allergies in at
and Drug Administration (FDA) for administered intramuscularly, and extra least two healthcare workers (with
use in humans. The technology was doses are still valid and encouraged for known multiple drug allergies),
first shown successfully in mice in use. All doses should be administered and one anaphylactoid reaction in
1990.1 Since then, significant leaps in within six hours. The vaccine efficacy someone without prior allergies.
technology have enabled its effective in preventing confirmed disease was Recommendations now are for those
use with good immune response. Phase 94.8% (95% confidence interval 90.3% with multiple drug allergies to avoid
I and II trials of mRNA vaccines have to 97.6%)2 after seven days of the vaccination, and to observe an individual
been done in humans for HIV, rabies second dose. There were nine cases in for 30 minutes after the vaccination.
and influenza, with good tolerability. the vaccine arm, and 172 in the placebo
The Health Sciences Authority of
At the end of 2020, mRNA vaccines arm. For severe disease, efficacy was
Singapore (HSA) has approved the
were proven highly effective (>94.5%) 66.3% (95% confidence interval -125%
Pfizer-BioNTech COVID-19 vaccine under
against the new COVID-19 virus with to 96.3%). There were only one case in
vaccine arm and three cases in placebo, the Pandemic Special Access Route for
a two-dose regimen. Emergency active immunisation against COVID-19
use approval was granted in several hence the wide confidence interval.
in individuals over 16 years of age.
countries, and the UK and US have Solicited local reactions are common
started vaccinating their citizens within with 96% of them being mild to Moderna’s investigational COVID-19
the same month. Unlike popular culture, moderate. The symptoms reported vaccine (mRNA-1273) was approved
current science does not support the include injection site reactions (84.1%), by FDA on 18 December 2020, but
incorporation of the mRNA vaccine fatigue (62.9%), headache (55.1%), has not been approved by HSA at the
into human chromosomes. The mRNA muscle pain (38.3%), chills (31.9%), time of writing. FDA assessed efficacy
are short-lived, cannot be transported joint pain (23.6%), diarrhoea (15.7%), and safety data from about 30,000
into the nucleus and lack the reverse fever (14.2%) and vomiting (2.0%). participants, randomised in a 1:1 ratio
transcriptase to integrate into human These symptoms were more than of vaccine to placebo.3 Efficacy in
chromosomal DNA. the typical vaccination at any clinic. preventing confirmed COVID-19 cases
16 JAN 2021 SMA Newsoccurring at least 14 days after the human adenovirus 26 for the latter. The against the current vaccines, one can
second dose of the vaccine was 94.5% overall efficacy for ChAdOx1 nCoV-19 easily imagine that the multitude of
(95% confidence interval 86.5% to was 70%, ranging from 62% to 90% with infected cases forms an easy substrate
97.8%) with five COVID-19 cases in the different dosing regimens. Ad26.COV2.S for a mutant virus to evolve against the
vaccine group and 90 COVID-19 cases has just completed recruitment of the tide of the vaccinated strain as countries
in the placebo group. The secondary Phase III trial with no reported results start vaccination. To be successful,
analysis suggested effectiveness in yet. Both vaccines had a temporary halt vaccination must continue with
preventing severe COVID-19 (zero in their Phase III trials because of safety virus curtailment strategies like safe
versus 11 cases in the vaccine and concerns, but were continued with their distancing and mask-wearing.
treatment group, respectively). safety board approvals later. With the evidence before us, it is
Duke-NUS Medical School’s now for us to recommend the approved
The vaccine tolerability was similar
collaboration with Arcturus Therapeutics COVID-19 vaccines for use in our
to BNT162b2. The most common
has led to the development of the patients. May the vaccine give us
solicited adverse reactions associated
mRNA-based Lunar-COV19 vaccine. the much needed boost in our fight
with mRNA-1273 were injection site
Phase III trials began in December 2020. against COVID-19.
pain (91.6%), fatigue (68.5%), headache
Unlike BNT162b2 and mRNA-1273,
(63.0%), muscle pain (59.6%), joint
Lunar-COV19 uses replicating mRNA
pain (44.8%), and chills (43.4%). Severe
technology, requiring only one dose, References
adverse reactions occurred in 0.2% to
stored as a freeze-dried powder. We 1. Wolff JA, Malone RW, Williams P, et al. Direct
9.7% of participants, usually after the
anticipate the results in early 2021. gene transfer into mouse muscle in vivo. Science
second dose. The vaccine had other
1990; 247(4949 Pt 1):1465-8.
adverse events of lymphadenopathy There are at least 60 to 80 other
(21.4%) and Bell’s palsy (three reports vaccine candidates, but many of them 2. U.S. Food and Drug Administration. Pfizer-
BioNTech COVID-19 vaccine (BNT162, PF-07302048)
in the vaccine group, and one in the will not survive the competition. CSL
vaccines and related biological products advisory
placebo group). was one such company. Though the committee briefing document. Available at: https://
vaccine had good immunological bit.ly/3rPG4St.
A traditional candidate response, it caused false positive HIV 3. U.S. Food and Drug Administration. Vaccines
results, making it impractical. and related biological products Advisory
CoronaVac, a COVID-19 vaccine by Committee meeting. Available at: https://bit.
Sinovac Life Sciences, Beijing, China Vaccine concerns ly/3hjzuPu. Accessed 25 December 2020.
uses a chemically inactivated SARS- 4. Zhang YJ, Zeng G, Pan HW, et al. Safety,
CoV-2 (CN02 strain) in pre-filled Despite the rapid development of the tolerability, and immunogenicity of an
syringes. They have published Phase vaccines from the expected eight to ten inactivated SARS-CoV-2 vaccine in healthy adults
I/II safety immunogenicity data.4 Two years to under a year, Singapore’s HSA aged 18-59 years: a randomised, double-blind,
adopted the same criteria for approval as placebo-controlled, phase 1/2 clinical trial.
doses are required over a 21-day Lancet Infect Dis 2020. Available at: https://bit.
with any other vaccine. These conditions
period. Seroconversion rates were at ly/2LJU7sL [Epub ahead of print].
were met by Pfizer-BioNTech. What was
least 93% in the Phase I/II trials, with
lacking was the long-term safety data. A
the media reporting similar results in minimum of 3,000 subjects followed up
Phase III trials. Final results on vaccine for at least six months is typically required Dr Leong is an infectious
efficacy have not been reported but to adequately characterise uncommon disease physician in private
are eagerly awaited. Unlike the other adverse events. practice. He is happily
vaccines, China reported that 1 million married to a paediatrician
Singapore has the benefit of observing with three wonderful
doses of vaccines (combined numbers children. He is passionate on
the effects of the vaccine on early adopting
from Sinovac Life Sciences and vaccination and education.
countries. At the time of writing, at least
Sinopharm subsidiary China National A change in the world must
1 million doses were administered in the first begin with the broken
Biotec Group) have been given under
US, and 600,000 in the UK. With time, any vessel he sees in the mirror.
emergency use. United Arab Emirates serious adverse events would be identified.
and Bahrain have similarly approved
the vaccine under emergency use. Vaccination is also a race against
the mutating virus, with two reported
significant mutations in 2020 alone
Other notable vaccine
(D614G in March 2020 and B117
candidates
in September 2020), conferring it
Other vaccines of deserved mention transmission advantages. The B117
include Oxford-AstraZeneca (ChAdOx1 mutation has allowed it to evade some
nCoV-19) and Johnson and Johnson neutralising antibodies developed as
(Ad26.COV2.S). Both use an adenovirus, treatment against COVID-19. Though
of chimpanzee origin for the former and there is no evidence of mutated strains
JAN 2021 SMA News 17Medicine and the Law:
New Section 37 on
INSIGHT
Standard of Care
for Medical Advice
Text by Eric Tin and
Dr Alex Cheng Wei Ray
On 6 October 2020, the Singapore Under the Bolam part of the test, a The Court’s shift towards a more
Parliament passed the Civil Law doctor is not liable in negligence if he can “patient-centric” approach follows from
(Amendment) Bill (No. 33 of 2020)1 which demonstrate that there is a respectable developments in the UK in the case
will come into effect imminently. The Bill and responsible body of medical opinion of Montgomery v Lanarkshire Health
introduced a new Section 37 in the Civil that accepts his practice as proper.4 Board.8 In Montgomery, it was held that
Law Act (CLA) to legislate the standard of The Bolitho addendum essentially when seeking consent to treatment, the
care that healthcare professionals have provides that the medical opinion adduced question of whether the information
to meet in giving medical advice to their must satisfy the threshold test of logic. given to a patient is adequate is judged
patients, which has hitherto been based from the perspective of a reasonable
on common law (ie, judge-made law The first subtle sign that the Singapore person in the patient’s position. Doctors
as decided in court cases). The Bill does Courts may eventually depart from the
have a duty to take reasonable care
not deal with, and does not affect the BB test for medical advice was around
to ensure that patients are aware of
existing common law on the standard of 2012. Then-Judge of Appeal Justice
“material risks”. The test of materiality
care for diagnosis and treatment carried Chao Hick Tin, in his extra-curial speech
is whether, in the circumstances of the
out. We will provide a brief background on informed consent delivered at the
particular case, a reasonable person in
of the law pre-Section 37, followed by 5th Chao Tze Cheng Memorial Lecture
the patient’s position would be likely
a commentary on the new Section 37, on 6 October 2012, made the following
to attach significance to the risk, or the
drawing substantially from its legislative prophetic remarks:
doctor is or should reasonably be aware
intention as discussed in Parliament. “If I were to be asked to give a one liner that the particular patient would be likely
advice, my answer will be this: Putting to attach significance to it.8
The Bolam-Bolitho test yourself in the shoes of the patient, what
would you have liked to know from the Under our local MM test, a doctor’s
A key aspect of medical advice is duty to advise requires that he/she
doctor? You are unlikely to fall foul of
informed consent, which generally refers disclose to a patient information that is
professional and legal norms if this is
to the process by which a healthcare relevant and material when giving them
your motto.”5
provider advises a patient on the risks, medical advice. The Court assesses what
complications, benefits and alternatives is relevant and material information from
The modified Montgomery test
of a medical procedure or intervention. the perspective of the patient. The MM
The patient must be competent to make Five years later, in 2017, a five-member test was borne out of the observation
a voluntary decision as to whether to Court of Appeal held in the landmark that the BB test did not sufficiently
undergo the procedure or intervention.2 case of Hii Chii Kok v Ooi Peng Jin London give effect to the principle of patient
Lucien6 that while the applicable standard autonomy and was regarded as too
By way of background, Singapore of care for diagnosis and treatment
Courts have been following and applying “doctor-centric”.
continues to be the BB test,6 as laid down
the Bolam-Bolitho (BB) test in respect of in Gunapathy,7 a new legal test was A doctor would fall below this
standard of care for medical diagnosis, minted for determining whether a doctor standard of care if he possessed
advice and treatment. The 2002 Court of was negligent in advising the patient. information that is important or
Appeal case of Khoo James v Gunapathy3 This came to be known as the modified reasonably relevant and material to
endorsed this two-part test. Montgomery (MM) test. the patient, and failed to inform the
18 JAN 2021 SMA Newspatient without any justification. The dump” which tends to cause the patient The general feedback was that
justifications for non-disclosure include to be more confused and less able to “Many doctors grew uncertain as to
waiver by the patient, emergency make a proper decision. what might be required of them when
treatment and therapeutic privilege. Another oft-cited criticism is that they saw a patient, advised a patient,
the MM test itself does not include the took informed consent as well as have
Whether a risk has to be disclosed
element of a reality check, save that it serious concerns as to whether the
depends on the severity of the potential rigour of the SMC system was sufficient
injury and its likelihood.9 In particular, suggests that expert opinion could be
to see through the case to get a clear,
a patient should have the freedom to taken into account when appropriate.
consistent, and certain outcome.”12
make an informed choice about their The test of materiality is solely from
the patient’s perspective and does not The Workgroup in particular found
medical treatment, consistent with the
take into account what is actually being that many doctors perceived the
ethical tenet of patient autonomy.
practised on the ground. In medical MM test as bringing in an element
According to the MM test, the practice, the three aspects of diagnosis, of variability and hence uncertainty
doctor only has to tell the patient advice and treatment can sometimes as to what each patient might want
about reasonable alternatives, but overlap, making it hard to clearly apply to know, since what is relevant and
the sufficiency of the advice and the test. material is said to be assessed from the
information will not depend solely patient’s perspective.
on the views of other respectable
doctors. Furthermore, a doctor must
Workgroup recommendations After extensive consultation
disclose information that he knows or Two years after Hii Chi Kok was decided with stakeholders of the healthcare
ought reasonably to know would be came the highly publicised Singapore sector, the Workgroup made three
important to that particular patient.9 Medical Council (SMC) case of SMC recommendations in relation to
v Dr Lim Lian Arn11 in 2019. In brief, informed consent:13
Medical professionals are therefore
expected to involve their patients SMC prosecuted Dr Lim for failing to 1. Provide a clear legal standard for
to a greater extent when advising advise a patient of the possible risks medical professionals’ duty to advise,
possible therapies or discussing and complications associated with a which is one that is patient-centric
treatment plans. Care should also be hydrocortisone and lignocaine injection. but ultimately based on the opinion
taken to record the patient’s particular The Disciplinary Tribunal accepted Dr of a responsible body of doctors.
concerns, and what medical advice and Lim’s plea of guilt and imposed the 2. Revise the SMC’s Ethical Code and
information had been imparted to the maximum fine of $100,000 as sought by Ethical Guidelines 2016 edition
patient as a result. his counsel, while SMC sought a five- (ECEG) on informed consent down
month suspension term. On appeal by to basic irreducible principles, with
However, a key concern with the MM the SMC, following strong reactions
test is that it would result in “defensive helpful illustrations to guide doctors
from the medical community, the on how these principles apply.
medicine”, whereby doctors dump
Court of Three Judges set aside Dr
excessive amounts of information onto 3. Develop nationally agreed specialty-
Lim’s conviction.
patients in order to avoid negligence specific guidelines to deal with
claims or complaints.9 Doctors are While Dr Lim’s case does not engage standard commonplace procedures
fearful of needing to “read their patient’s the interpretation of the MM test, it in each specialty.
mind” to predict concerns that were not catalysed further discussions on the MM
divulged by the patient at the clinic in test during the town halls conducted by The overall intention is not for
order not to be considered negligent.10 the Workgroup to Review the Taking of the guidelines to be prescriptive,
This is notwithstanding that the Court Informed Consent and SMC Disciplinary but to serve as a source of reference
of Appeal made clear in Hii Chii Kok9 Process, which was formed by the Ministry or as a baseline. In summary, these
that the doctor’s duty to advise is not of Health in March 2019 to look into these recommendations aim to restore the
satisfied by conducting an “information areas after Dr Lim’s case was reported.12 doctor-patient relationship, promote
patients’ interests and reverse the trend
“ inTheitsvalue
of defensive medical practice.
of Section 37 lies Rationale for Section 37
spirit of bringing peer Section 37 is essentially the statutory
embodiment of the Workgroup’s first
professional opinion back as a recommendation, combining aspects of
the BB and MM tests.
gatekeeper while giving effect Section 37 is intended to set a clear
standard for healthcare professionals’
to patient autonomy in the “ duty in giving medical advice to their
patients, to enhance decision-making
realm of medical advice. and outcomes for the patient, rebuild
trust between doctors and patients, and
prevent defensive practices.
JAN 2021 SMA News 19At one level, Section 37 aims to A legally disabled person is some- Material information
remove the dichotomy that one has one who does not have the mental Material information may relate to
to be either patient-centric or doctor- competence to make a decision for specific concerns or queries that the
centric, rendering the patient and himself or herself. For example, a parent patient expressly communicates in
doctor constantly pitted against one would be responsible for making a relation to undergoing the treatment or
another in a zero-sum game. A legal decision on behalf of his infant child. the medical advice, such as an expressed
test which coheres with a patient and question, query or some discussion
his/her doctor jointly managing his/ Standard of care for medical advice raised by the patient and if the doctors
her medical outcome is felt to be the The Section 37 test provides that a are asked specific questions, that
better way forward.12 healthcare professional will meet the becomes something he has to explain.
At another level, it seeks to balance standard of care in giving medical Material information may also relate
preserving the principle of patient advice to a patient where two to specific concerns or queries which the
autonomy and upholding the principle conditions are satisfied.12 patient does not expressly communicate,
of self-regulation in the medical Firstly, he acts in a manner which is but which ought to be apparent from
profession, by providing that regard the medical records of the patient
accepted by the medical opinion of a
should be had to what peer healthcare which the healthcare professional has
respectable body of such healthcare
professionals say as to the appropriate reasonable access to, and also ought to
professionals as reasonable professional
standard of care in giving a patient reasonably review.
practice in the circumstances (peer
information. The Courts will continue professional opinion). In relation to information that ought
to have oversight, by ensuring that the to be apparent from medical records,
views of peer healthcare professionals Second, this peer professional opinion this is not intended to impose an
pass muster when it comes to logic has to be logical, in that it has compared obligation on healthcare professionals
and reasonableness. and weighed the risks and benefits of to review and go back into reviewing
the conduct in question and arrived at a substantial volumes of medical records,
In concept, Section 37 is not a
defensible conclusion that is internally or voluminous medical history on the
fundamental shift in direction. The
consistent and does not ignore known National Electronic Health Record in
underlying principles would be
medical facts and formulation. order to try and work out or ferret out
familiar to doctors and lawyers alike,
concerns or queries that the patient
and they are ones which are currently These two conditions essentially
might have.
established in law. incorporate the same legal principles
that were used to assess healthcare The litmus test is that of
What Section 37 does not change professionals’ conduct using the BB test. reasonableness, both in terms of
what the healthcare professional has
Section 37 does not alter the burden of Three Limbs of peer professional reasonable access to, and also whether
proof in a medical negligence claim. The opinion in the circumstance of the case, the
claimant patient continues to bear the discussion with the patient or the
burden of proving his/her case on the There are three limbs under which
context in which the patient is seeing
civil standard of balance of probabilities. the peer professional opinion must
the doctor creates a scenario where
assess the information given by
Section 37 also does not change the the doctor ought reasonably to review
healthcare professionals:12 these past records. What is reasonable
test for medical diagnosis and treatment,
which continues to be the BB test. In the First Limb, the healthcare is a matter to be assessed in the
professional must give his patient context of each case, and it is not
information that a “typical” patient possible to define upfront at the start
Unpacking the new Section 37
would reasonably require to make an all the categories in a closed fashion
The following section draws informed decision about whether to of information that will be regarded as
substantially from Section 37’s undergo treatment or follow a particular reasonable or not reasonable.
legislative intention as discussed in piece of medical advice. This provides A factor that would go into the
Parliament, and as reported in the for what a doctor might do to a typical assessment of what is reasonable is the
Ministry of Health’s news highlights. patient that is judged by what his or her age of the medical records in question.
peers would regard. In general, the older the medical records
Scope of Section 37
are, the less likely it would be that it
Section 37 applies not only in respect In the Second Limb, the healthcare
would be reasonable to expect the
of medical advice given to patients, professional must give his patient healthcare professional to review them.
but also medical advice given to a information that he knows or reasonably But if something is flagged out in the
person who is responsible for making a should know is material to that “specific” old medical record which suggests
decision about undergoing a treatment patient, for the purposes of making the a need to make a train of enquiry, it
or following a particular piece of medical same informed decision as in the First would make it harder for the healthcare
advice on behalf of someone else, that Limb. It requires the professional to also professional to say that it is not some-
someone else being a patient who is think about what might be material thing that he ought not to look at in
legally disabled. information to this patient. context of this treatment.
20 JAN 2021 SMA NewsYou can also read
