Letters to the Editor
THE TASKS AHEAD
This year, the SMA is 38 years old. Come 1999, Singapore Medical Association (SMA) would be 40 years old. It was founded when Singapore gained independence in 1959. At that time, SMA was the only organisation representing doctors. Today while there are more than 160 healthcare organisations, SMA is still the largest organisation of doctors. It is, de facto the national institution that represents the medical profession in all but purely academic matters in healthcare.
The past 10 years have been particularly eventful.Buffetedbywindsof thefreemarket,the fabric of medical ethics and practice has been stretched and strained. SMA as the national institution has to re-define itself to meet these challenges head-on. The past years have seen SMA clarify its role vis-a-vis other healthcare organisations. It leaves technical issues concerning academic accreditation and continued medical education to the College of Family Physicians and to the Academy of Medicine. In all other matters, it has asserted leadership. It has obtained the consensus of the medical profession on issues such as medical advertisement. It has facilitated the work of other fraternal organisations. It has asserted its position in many issues relating to healthcare policies and economics. These are by no means all the challenges.
We therefore need to further strengthen SMA as an institution. It may wish to study how best to engender participation of more doctors so that the collective energies of the profession can be harnessed. It should ensure that the aspirations and interests of doctors of different seniority are represented. It should also define its role in shaping healthcare policies and in managing issues of relevance to the ethics and practice of medicine.
The SMA code of ethics has also to be brought up-to-date so it could be a ready resource of reference for all ethical matters. A continuing dialogue has been started with the Singapore Medical Council (SMC). Many non-statutory complaints from members of the public are now re-directed by the SMC for the attention of the SMA ethics committee. The workings of the ethics committee should therefore be further clarified and made transparent by the next Council so that both doctors and members of the public understand how complaints about doctors or the healthcare system are dealt with and redressed.
In the past year, there was a spate of publicity on cases involving civil suits by patients against doctors which were settled for astronomical sums. SMA has discussed this trend with the medical defence organisations. The enlarged role of the Ethics Committee as worked out within the profession is fortuitous and would be helpful. We are also looking into the possibility of the participation of local doctors in medical case committees of the defence organisations through the SMA. The inclusion of alternative solicitors by both defence organisations last year was brought about by the strong feedback given. SMA in the next few years must set the structure for the defence organisations, the local solicitors and doctors to manage the volatile indemnity scene.
In a market-place of healthcare where the Gnseen hand' seems all powerful, SMA has a public duty to ensure that good medical practice is encouraged, training and research are not side-lined and society's well-being is safe-guarded. It could do this by inviting discussion, by ensuring a transparent flow of information by activating the collective will of the profession and by making representation to the parties involved. The Council has begun the first steps in finding and publishing surveys on practice matters and by merging the SMA NEWS and the Singapore Medical Journal (SMJ). The new SMJ would be the crucible of the change and revitalisation for the medical profession. The SMA has also organised focus groups and committees to engage pressing healthcare issues and fostered closer relationships with the press and other institutions.
The 37th Council began its term with a punishing pace a year ago. Before it had time to re-examine in depth a proposed guidelines of medical advertisement, it was summoned to appear before the Select Committee on the matter of practice costs and consultation fees of general practice in Singapore. It had a breather in its midterm to look into its relationship with the Singapore Medical Council and strengthen its position of leadership in the region. It has built strong fraternal ties with the Myanmar Medical Association and with other medical associations in ASEAN. The past months have been focused on establishing SMJs relevance not only for Singapore but for the region. It has also co-opted into its team at various levels new doctors who are prepared to work for the betterment of the profession. Some of these doctors are standing for election this year
We have done what we have to, as best we could. The baton will pass to the incoming 38th Council on 12 April 1997.
Cheong Pak Yean