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Personally Speaking - "The Doctor-Patient Relationship and the Redundancy of Rules"

A Good Doctor-Patient Relationship: much has been written and spoken about this entity. It is almost cliché.

What exactly is a good doctor-patient relationship? A relationship takes two parties to nurture. Much of what takes place in a relationship remains unwritten but understood. If everything were to be written down and signed, then it would be documented as a contractual relationship between signatories. But a doctor-patient relationship is more than a blunt legal contract. While good case-notes are a cornerstone of good care, they only represent medical and factual recordings of this relationship.

It is a relationship where doctors undertake the following (non-exhaustive) to their patients:

a) to be non-maleficent (do no harm)

b) to be beneficient (do good)

c) to respect patient confidentiality

d) to respect patient autonomy and self-determination

e) to be truthful and not withholding relevant information

It is a relationship whereby patients undertake on their part to also reciprocate with the following (also non-exhaustive):

a) to be truthful and not withholding relevant information

b) to consent to be questioned and physically examined

c) to be compliant with doctors’ advice and management to a reasonable degree

d) to make payment for services rendered (when there is no third-party payment)

All this takes place against the backdrop of the law of the land, and common etiquette and courtesy expected of a reasonable and responsible adult. Some of the above obviously do not apply to children, and psychiatric and certain severely ill patients. The doctor-patient relationship is therefore one of trust and mutual respect, without the need for written contracts, formal or informal. We believe that this is the way for a good doctor-patient relationship to develop, which in turn is crucial for good care.

Now, in the light of this, what do we make out of Dr Charles Loo’s rules for his 6-10 Clinic & Surgery as reported on 2 November 98 in The Straits Times? Not only are his rules under scrutiny, but the nature of the doctor-patient relationship as well. But let us first examine his Rules. Certainly, upon careful scrutiny, there is nothing that is blatantly unethical about the Rules. They do not really put the patient at any great disadvantge. In fact, there is much truth in what Dr Loo claims, "all the rules are about common courtesy and etiquette". However, the fact that rules are so declared for "common courtesy and etiquette" demeans if not nullifies the quality of the common courtesy and etiquette so obtained. More importantly, can a good doctor-patient relationship arise and grow out of such an "adversarial" and "distrustful" stand?

Making patients sign an agreement like 6-10 Clinic, while not unethical, is not the way to go. In fact, such practices could be the beginning of a severe erosion of the doctor-patient relationship. Certainly, we do not want to go the way of some developed countries whereby patients are made to sign a tome of agreements and disclaimers by the health provider. Trust and mutual respect should still be the order of the day. And when expected but unwritten obligations are not taken up by any party in the doctor-patient relationship, then the other party can abrogate such a relationship. There will always be unreasonable patients and unsatisfactory doctors. Over time, doctors and patients alike can choose who they want to work with. Doctors should assume in the beginning that all patients will play their part in the doctor-patient relationship, not otherwise.