Letters to the Editor
The floatation of Raffles Medical Group (RMG) on the Sesdaq second board on 31st March 1997 has raised many eyebrows both within and outside the profession. Despite its Chairman, Or Loo Choon Yonds promise that the patients interest will come first, a Straits Times editorial (ST 3 Apr 97) expressed reservations. The editorial observed that 'His is a controversial venture. Investment analysis and professional trend-watchers will be interested in its impact on the public for vastly different reasons' (reference 1).
Indeed, all eyes will be on RMG. Logic dictates that it is going to be difficult to serve the interests of shareholders and patients to the same level of commitment. Such a situation is not entirely new to doctors who have to practise as company doctors. They have often to tread a fine line to balance the employer's interests against the patient's interests. The difference now is that instead of the employer there are now the shareholders. Is there a solution?
Basically, the doctor has to remain the patient's advocate to safeguard fair dealing. It is important to make it clear to all parties involved: the doctors, the shareholders and the patients that doctoring is only meaningful if it serves the patient's interests. It can also be argued that without such a promise in real medicine, there would be no point for the patient to attend.
The issue of conflicting interests has been addressed in books on medical ethics. One such book is "Ethical Analysis of Clinical Medicine" by Graber et al. It has a chapter on the scope of the physicians behaviour under such circumstances. This paradigm places the primary interest of the doctor in "the diagnosis and treatment of an illness or injury for an individual who presents a complaint within the context of an established therapeutic consultation" (reference 2 page 118). This ideal "implies an interest and right on the part of the doctor as well as to maintain the integrity of his activity, to work not as a tool or as a bureaucratic agent of a social system, but as one whose professional activity is a personal expression of his own nature, the relationships he enters into being freely chosen, the obligations free assumed, not imposed" (reference 3 page 1 19).
It is important for RMG to promote this ethical paradigm as the core of its organisational culture if it is going to realise the promise of its Chairman that the "patient will always come first" (reference 4). All shareholders must share the same ethical paradigm. If they do not, then it would be better for them to invest in other portfolios.
Goh Lee Gan