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The Profit Guarantee: A Sign Of The Times?

"Should we accept it as the sign of the times? Or should we remind doctors
of their promise to society- to relieve suffering - as their manna and regard
making money as a secondary concern?"

Doctors are aware of the meaning of caring for the patient. They are also aware of the constant tussle between patient interest and self interest. The world has become commercialised. Money is increasingly seen as a symbol of success. The latest commercial arrangement to hit the profession is the profit guarantee. Is this a sign of the times?

The gut feeling among many doctors is this has gone out-of-bounds of what is acceptable to the medical profession. We are seduced by the charm of the so-called "free market forces" without balancing this with the long tradition of medical ethics that has been the guiding light to the profession. "Free market" is seen as a panacea. We have forgotten where our values should be anchored.

What is doctoring? Is it the age-old promise and commitment to the patient and the community that the doctor will use his healing hand to reduce suffering? Or is it a means to increase earning capacity?

The changing climate of medical practice has evoked different emotions. To some there is despair and a sense of helplessness. See Dr A’s letter to the SMA President. Some get angry and resign from the SMA. See letter from B.

The SMA Council has decided that the profit guarantee puts the doctor at risk of unethical behaviour and discourages doctors from being a party to such commercial arrangements. Some doctors who are waiting to jump on the bandwagon may get angry and view this as whistle blowing. It is encouraging that the Singapore Medical Council has supported the resolution passed by the SMA Council.

To the doctor As and Bs in our medical profession, we need to move beyond despair and anger. These are emotions of futility. We need to encourage every thinking person in the medical profession, in the public, and in our Goverment to reflect on the increasing commercialisation of medical practice. Should we accept it as the sign of the times? Or should we remind doctors of their promise to society - to relieve suffering - as their manna and regard making money as a secondary concern?


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The Government’s position on profit guarantee was reported by the Straits Times and the Business Times on 21 April 1998. The subject was tabled by Mr Choo Wee Khiang, MP for Jalan Besar GRC on 20 April 1998 at the Parliament. He wanted to know how profit guarantee would affect the standard of medical practice here. This follows the recent Business Times report on the deal struck in February between AsiaMatrix and four specialists in private practice. The doctors guaranteed AsiaMatrix a $4.36 million share of the profits annually for five years beginning on Jan 1, in exchange for it acquiring majority stakes in their businesses.

In reply, the Health Minister, Mr Yeo Cheow Tong said that "the Health Ministry supports the strong stand taken by the Singapore Medical Association (SMA) on the issue of doctors giving profit guarantee". "These", said Mr Yeo, "will put them at greater risk of unethical behaviour as they are working under purely financial imperatives imposed by a third party." The SMA’s resolution was also supported by the Singapore Medical Council.

Mr Yeo said that the four specialists "do not contravene any existing laws, and the parties do not require the ministry’s approval." But he added that the Ministry is "very concerned with any commercial transaction... which can lead to a lowering of our high professional and ethical standards of medical practice." "We must remember that the doctor-patient relationship is different from other consumer-provider transactions, where the consumer has sufficient knowledge of the service or product to make an informed choice. It is therefore vital... that the doctor remains professionally independent to do what he believes is best for the patient."

He added that the Ministry of Health will conduct more intensive audits on medical establishments at greater risk of compromise of professional or ethical standards, and will not hesitate to act decisively to bring errant doctors before the Singapore Medical Council when needed.

"Doctors who enter into business arrangements must be circumspect and avoid any situation or arrangement, which would potentially compromise their professional independence and their patients’ interests.", said the Minister.


The Journal of the American College of Physicians, warned on Tuesday, 14 April 1998, that US society was losing confidence in the ability of physicians to curb their appetite for money. The Annals of Internal Medicine, which the doctors’ group publishes, said in its latest issue that a public loss of faith in medical ethics could be seen in efforts by the Congress and the Clinton Administration to crack down on physician fraud.

"I hope that we in Singapore do not end up in the same boat..."
Professor SY Tan,
Professor of Medicine and Adjunct Professor of Law
of University of Hawaii

"That society should see a need for laws to protect patients from their physicians is disheartening, "an editorial in the journal by Dr M Gregg Bloche, a medical doctor and legal expert at the Georgetown University Law Center in Washington said, "Physicians should heed the sobering message the laws send - that Americans have lost faith in their physicians’ ability to restrain themselves when tempted by money."

The American College of Physicians, which represents more than 100,000 doctors, has joined the American Medical Association and other groups to seek new ways to root out abuse and punish fraud while reducing unnecessary burdens on doctors.

The College Journal’s Editorial also called on the medical community to recommit itself to the Hippocratic Oath, which embodies the essence of medical ethics. "Restoration of people’s confidence in the medical profession’s willingness to keep faith at the bedside should be a higher priority for physicians than criticism of the fraud and abuse laws." it said.

Source: David Morgan from Reuters, 14 April 1998

Editor’s note:
The Editor wishes to thank Professor SY Tan for sending this piece of news from Reuters