The Ministry of Health (MOH) recently issued guidelines to medical practitioners on the communication of medical information over the phone.

The move came after the High Court overturned a Singapore Medical Council (SMC) conviction of  psychiatrist Soo Shuenn Chiang for failing to protect his patient’s information. I am glad that MOH has come up with the new set of guidelines, and the hope now is that the public will also be better informed about what information they can and cannot ask from doctors.

A few days after the MOH circular, I received a call in my clinic.

“Dr Wai, this is Mrs A, you discharged my husband this morning. Can I ask about his condition? Actually, what was wrong with him?” she asked.

When Mr A was first admitted under my care, he was accompanied by five individuals. Mr A told me they were his wife and in-laws.

I probably met Mrs A that night. But Mr A did not specifically introduce every one of his relatives. Neither did he specifically give me instructions to release his medical information to anyone, including his wife.

Mr A was hospitalised for three days. Before I discharged him, I went through with him the investigation findings, my interpretation and recommendation.

So I could not understand why someone was now on the line asking me about Mr A’s condition. If she was Mrs A, couldn’t she have asked her husband directly?

Perhaps Mr A had no opportunity to speak with her. Or, Mr A could not explain medical terms properly.

Often, patients’ relatives want to hear directly from the doctor, rather than from the patient. Or maybe Mrs A was busy at work or at home, that she could not find time to meet me in person in the hospital during Mr A’s hospitalisation.

It is certainly logical and understandable that she requests a phone update. Yet on the flip side, how do I know the caller was indeed Mr A’s wife?

The MOH guidelines suggest doctors ask for three identifiers, such as name, NRIC, date of birth, to confirm Mr A’s identity.

But what if the caller is Mr A’s ex-wife, or close relative, who is not on friendly terms with Mr A and who might have their own reasons for wanting to know his medical condition. Close relatives or an ex-spouse would know common identifiers of the patient.

Even if she is truly the beloved wife of Mr A, how do I know that Mr A agreed for his medical information to be released to his wife?

How about documentation? Even if Mr A verbally allows me to release medical information to his wife, how should I document it?

Could I just document in my case notes that Mr A agrees to have his medical information released to his wife? Or do I need Mr A to sign a proper consent in black and white?

Medical practitioners have in the past tended to err on the side of compassion. If we have good reasons to believe the caller is indeed a close relative or spouse, and we feel the medical information is not too private, we usually oblige and would update patients’ family over the phone.

But Dr Soo’s case has changed the landscape.

His initial conviction caused an uproar among the medical community, with many doctors arguing that the penalty of a S$50,000 fine was too harsh.

Even though the conviction has been set aside, doctors have become much more careful and would err on the side of caution when it comes to releasing patients' information. 

In overturning the SMC ruling, Chief Justice Sundaresh Menon spelt out certain conditions for doctors to provide a patient’s confidential medical information to his family without the patient’s consent: The patient must be protected from potentially serious self-harm, it is in the patient’s best interests, and the patient’s consent cannot be reasonably obtained. 

The exceptions are clear and well defined.

Mr A’s condition does not fulfil any of these criteria.

I apologetically told the caller: “I am sorry I cannot disclose anything to you. I cannot ascertain your identify, and I could not obtain consent from your husband. Though my gut feeling is that you are really his wife, I cannot disclose any information to you.”

I added: “I know I sound very uncaring and unsympathetic, but our rules are very strict. I hope you understand. I can tell you Mr A is not in any serious condition. If he is, I can break the rules to tell you.”

Thankfully, Mrs A understood and thanked me for the phone conversation. 

Two days later, Mr A came to my clinic for a review, accompanied by his wife. I asked: “So Madam, were you the person I spoke with on the phone?”

She replied,” Yes, I am. It’s okay. I understand.”

Mr A added: “She wants to hear from you about my condition, rather than from me.”

We spent the next 20 minutes going through all the tests, reports, my diagnosis, and recommendations. At the end of it, they thanked me. I am lucky to have understanding relatives of patients like Mrs A.

In my 20-odd years of practice, many relatives of my patients have called up my clinic directly to ask for updates on their loved ones.

I usually oblige, as I understand that it is difficult for working Singaporeans or even housewives to take leave to meet me in hospital.

When my father was admitted for an operation a year ago, I could not go to his hospital to meet up with his doctors during office hours. But they were kind enough to update me via the phone.

Doctors have always been mindful of the strict SMC rules on one hand, and the importance of being flexible on the other hand.

Dr Soo’s case is a good wakeup call for all doctors that we should follow the MOH and SMC rules strictly.

The MOH guidelines are not exactly new to doctors, as these rules are already listed in the 2016 SMC Ethical Code and Ethical Guidelines.

The latest MOH guidelines are perhaps more for patients and their families. Patients must understand that SMC and MOH rules disallow doctors from disclosing medical information to anyone, unless there is documented patient’s consent.

It may sound legalistic and regimental, but the best way for family to know the patient’s condition is to go to the hospital in person, and ask the patient to give consent to his medical team to have his medical information released to the family.

The public must understand these are the rules that doctors must follow and not expect them to break them without good reason, as the penalty for doing so can be hefty.

ABOUT THE AUTHOR:

Dr Desmond Wai is a gastroenterologist and hepatologist in private practice.