SINGAPORE — Doctors must not charge fees of a level that would bring the profession into “disrepute”, and fees must be charged for services directly rendered by the doctor or those under his supervision, and not levied on top of fees paid to other doctors by the patients.

This notice was part of a 64-page revised ethics code and guidelines for doctors released on Wednesday (Sept 14) by the Singapore Medical Council (SMC), but the council stopped short of directing a body to set fees — which was a suggestion mooted by a committee tasked with looking into the disciplinary processes of doctors in 2014.

Explaining the decision to set the guidelines, the SMC said: “The community looks up to doctors as being part of a noble profession.

“As such, profit motives must be subservient to treating patients in their best interests.”

It said that fees charged “must be fair and reasonable and commensurate with the work actually done and the circumstances in which it is done”, and the “appropriateness” of the fees is “subject to the review of peers”.

The council also stressed that when doctors collect fees on behalf of other doctors who have assisted in the overall care of their patients, they must not take extra fees for themselves if they have not “materially provided any part of the services” of the other doctors.

While fees must be made transparent to patients, the patients’ acceptance of the fees does not absolve doctors of the responsibility of charging reasonable fees.

The issue of fee guidelines for doctors has been a contentious one, beginning in 2007 when the Singapore Medical Association (SMA) removed its guideline on fees after being told that it could be infringing competition laws.

Its appeal to the Ministry of Trade and Industry failed, and the Competition Commission of Singapore issued its final decision in 2010 that the guidelines were anti-competitive.

However, the question of ethical fee limits came under the spotlight again during the Susan Lim case in recent years, when the Court of Appeal ruled that the S$24 million charged by the surgeon in treating a royal from Brunei had gone beyond what should be morally charged, and it suggested that the SMA publish the fees charged in the private sector.

The surgeon’s professional misconduct included 11 charges of falsely representing in her invoices that the fees stated were charged by third-party doctors, when she had really marked up the actual fees significantly.

On Wednesday, Dr Tan Chi Chiu, chairman of the working committee to review the ethics code and guidelines, said: “The practice of medicine has become more commercial and business-like in the last 14 years, even more mercenary in some ways. Fees per se has become an issue. Look no further than the saga of Dr Susan Lim to know we should talk about fees.

“So, how do we educate doctors on fees? We expect doctors to create fees based on their expertise and work, not to charge fees that are arbitrary or have no sound logical basis. They should not take advantage of patients’ ignorance.”