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    News From Council

"SMA Ethics and Practice Convention 1998"


The SMA gave its views to the Singapore Medical Council (SMC) with regards to referrals for radiological investigations from other than SMC registered medical practitioners.

SMC’s Ruling

In a reply dated 23 Nov 1998 to the Honorary Secretary of the Singapore Radiological Society, a copy of which was given to the SMA, the Executive Secretary of the SMC wrote –

"There is no place for registered medical practitioners to associate with non-medical practitioners including referrals from chiropractors and traditional Chinese physicians.

"Self-referrals should be discouraged. Nevertheless, in the case of walk-in patients, a radiologist should function as the primary care practitioner and if there is any abnormality in the findings, he has the professional duty to ensure that there is continuity of care for the patient. He is professionally liable if he disregards his professional duties to arrange for treatment for a patient when necessary."


The SMA Council supports the above SMC ruling for the following reasons.

1. SMA believes that the duty of care owed by a radiologist is different in the following two instances:

1st Instance: a patient who is referred by another registered medical practitioner for a radiological investigation

2nd Instance: a patient who is self-referred.

2. Any investigation - whether radiological, biochemical, hematological, etc - can be divided into 3 stages. This so-called investigation process is as follows

1st Stage: Ordering of an appropriate investigation

2nd Stage: Performance of investigation and production of results/reports

3rd Stage: Result interpretation as part of the subsequent management of the patient

3. In the 1st instance when the investigation is performed at the request of another SMC registered practitioner, the radiologist’s duty of care to the patient on whom the test is performed is basically limited to the 2nd stage: the performance of test and production of results. The responsibilities for the 1st and 3rd stages reside with the doctor who requested for the test.

4. However, in the 2nd instance, the radiologist must assume professional responsibility for all 3 stages. Firstly, he assumes the role of a radiologist in the 2nd stage. Secondly, he has also to provide care in the 1st and 3rd stages as the primary care doctor as well. This is because when a patient undergoes an investigation, he should be entitled to the care of a qualified and trained person for all stages of the investigation process.

The SMA has clarified with the SMC that it is permissible for a radiologist under such circumstances to also provide primary care. The SMC’s view on the issue is reflected in their reply to us on 18 Nov 1998.

"The purpose of the Specialist Register is to let the public and other doctors know that such a doctor on the Register possesses special knowledge and skills related to that specialty. It does not prohibit the doctor doing everything else that the MBBS degree allows him to do. For specific procedures, unless he is trained and maintains his competency, it would be foolish of the doctor to perform them."

5. Therefore, in the 2nd instance, to ensure that the results of an investigation are correctly ordered (1st stage) and meaningfully interpreted (3rd stage) for the benefit of the patient, the radiologist performing or permitting the investigation or producing the results and reports is also duty bound to ensure the right investigations are ordered and the corresponding results and possible management alternatives are explained to the patient, ie. as an attending primary care physician. The radiologist may also, in such instances, charge an appropriate consultation fee for the services rendered in the 1st and 3rd stages of an investigation process according to the SMA guideline of fees for general practitioners for such services rendered.

6. However if the radiologist routinely functions as a primary care doctor as well, it is professional courtesy to inform doctors referring patients to him as such.

Similar principles apply for investigations other than radiological.