Letters to the Editor
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"Seminar on Medical Profession and the Media"Paper on "Consumers Perspective" by Stephen Loke, Chairman of CASE Consumer Affairs Committee, at COMB Auditorium, College of Medical Building, College Road on Sunday, 15 November 1998.
(BG(NS) A/Prof Lim Meng Kins paper will be published in the next issue of SMA News.)
When I was first asked to speak on this topic, I balked a bit as it is an area seldom ventured into by consumer stalwarts like us. But after some thinking, the upside really is that I would not be constrained by the many thoughts on this subject made already somewhere out there.
Good afternoon, ladies and gentlemen. It is my pleasure to be able to address you this afternoon on this topic and I trust that I will be able to offer some guidance into the thinking of the consumer. While there is an apparent dearth of information on this subject, I believe that such apparent absence and silence from consumers should not be construed as a blank cheque from them on the matter.
As a prelude, I would like to commend the organisers of this seminar for recognising that there must be a bridge formed between consumers and medical practitioners for the transfer of information from one to the other and in this respect the media plays an important role and as that bridge. This seminar is, in the circumstances, a step in the right direction and an opportunity given to garner from and share with each other views on this important subject.
Before going any further, let me first define our concept of the media, in this instance, the mass media, being newspapers, radio, television, magazines, newsletters and now the Internet. As you would be aware, the Internet is now playing a growing and bigger role in our community and in so far as mass communication is concerned as the younger people who are trained in Information Technology (IT) start to join society. Particular attention needs to be paid to this new form of mass communication.
Without a doubt, the mass media plays a vital role in communicating and disseminating information to the public at large. It can through disseminating information, motivate action, build public confidence and support, exert pressure for reform and most importantly, the media can enlighten and heighten consumers awareness on topical issues of the day.
As such it is important to have a responsible media and I believe in Singapore the media owners have a Code of Ethics which they follow. Should this fail, the Ministry of Information & The Arts (MITA) keeps a watchful eye and this is usually deterrent enough.
Coming back to the content of this discussion, one of the ways the media can propagate members of the medical practitioners is through advertising. The definition of advertising in connection with the medical profession is found on page 12 of the Singapore Medical Association (SMA) Code of Ethics which states that it "must be taken in its broadest sense to include all those ways by which a person is made publicly known, either by himself or by others without objection on his part, in a manner which can fairly be regarded as for the purpose of obtaining patients or promoting his own professional advantage, or as appearing to be for these purposes. A doctor is expected to build his or her professional reputation based on ability (eg. medical skills and knowledge), integrity and good professional conduct."
The important thing is that a doctor when advertising within the realm of the Code should be honest as to what he or she can hold himself or herself out to be to the public. For example, there are some specialists who may hold themselves out to practice general practitioners (GP) work and vice versa when GPs hold themselves out to be specialist of sorts.
As an example or illustration of a negative or an unacceptable form of advertisement on doctors can be found in the recent incident where a doctor had been censured for touting for patients and in a most novel way. I believe that you would know how a doctor should advertise himself or herself and I will not dwell on this area too long as it is spelt out quite clearly in your Code.
What consumers hope to see is a comprehensive and authoritative guide which would show the professional standing of doctors and their areas of practice. Consumers therefore need not be deluged with a flood of disorganised information and for their consumption and deliberation. In this regard we hope that SMA or some medical organisation would take the initiative to compile such a book and for the benefit of consumers at large.
What about the rights of the consumer to information on medical treatment and ailments? How much is enough? Let me say that what I say now is only a guideline and not authoritative.
Right to information
Whilst it can be said that one of the fundamental rights of consumer is to information if such information is not given in perspective and particularly when it relates to the medical field, it can be a dangerous thing.
Consumers are entitled to information from the medical profession on the nature of treatment, types of treatment, advances in treatment and so on. It is the duty of the profession to ensure that such information is disseminated Promptly, Accurately, Completely and Efficiently (PACE).
Promptly Information should not be kept under rugs or swept under the carpet for long periods of time. Information should be disseminated within reasonable time and for the public to be aware of the quick changing pace of the medical scene. Doctors should themselves keep up with the latest medical know-how and equipment and to provide adequate level of services to consumers and in accordance with current practice. If information is withheld by the professionals, then consumers can only rely on unofficial sources of to base their decisions on and such could be to their detriment.
Accurately Information must be scrutinised to ensure that it is precise and understandable to the consumer. It should where possible be devoid of high sounding technical jargon and be in plain English. Facts should be clearly distinguished from opinions for the (layman) consumer.
Completely Information should not be in half measure and therefore misleading. Any distilled information must contain sufficient substance for consumers to be discerning and make use of such information to make informed decisions. Remember the lack of information or information inaccurately transmitted could cause lives in the case of medical practitioners.
Efficiently Information should be transmitted through the mass media and the appropriate medium must be chosen to ensure maximum exposure of the information and to reach the maximum target audience.
Perhaps it is useful at this juncture to touch upon what type of information consumers should be given. As we are laymen, the list here is by no means exhaustive but as a guideline to be considered:
1. Medical conditions or ailments A consumer is entitled to be informed of the latest medical conditions which exist whether it be newly discovered or evolved, for example, Aids when first discovered in humans, flesh eating bacteria, super flu bugs, mad cow disease and so on. This is important to alert a consumer to be aware of his environment and the dangers that may lurk within as the saying goes, prevention is better than cure.
2. Advancement in treatment It is important that information relating to advancements in treatment should be disseminated at its earliest opportunity to consumers and such information must include the downside or risks in such treatment if such treatment is not fully developed. A case in point would be when a medical practitioner was struck off the Rolls for misinforming patients with cancer and tuberculosis that Autologous Target Cytokines (ATC) therapy could cure their problems. Unfortunately, the procedure was not recognised by the medical profession and classified by the Ministry of Health as a medical product under the Medicines Act. Clearly before this case had come to light to the public at large, consumers had not heard of the downside of ATC treatment at all and we feel that there can be some improvement made in this area. Whilst prompt action was taken by your council once this case came to light, it was too late for some. Could this incident have been avoided through better use of the media to communicate with the public as to the actual controversies surrounding this treatment? I regret to say that whilst I cannot give you the straight answer to this question but I cannot help but suspect the ending may not have been so unhappy.
3. Drugs Advancement in medicine brings with it breakthroughs in dealing with all forms of diseases and ailments and sometimes involves a whole range of drugs, some new and some old. An example of a new and somewhat controversial drug would be Viagra which seems to attract a stream of medical reports from around the world consumers are entitled to know whether the results of consumption of this drug are still to be subject to scrutiny or reliance can be placed on end results so far achieved by researchers and medical scientists. As for old drugs, just as an illustration, I was brought up knowing and trusting Ampicillin which for many years was dispensed in a familiar red and black capsule which cost some fifty cents for each capsule and when I was a young boy. Now, I believe if I were to be a young boy again, I would never be able to recognise the drug and with the same confidence as I did before because the patent for the drug had expired and it now comes to consumers in a mass of coloured capsules. Rightfully or wrongfully as a consumer when they see a multitude colour of capsules appearing they begin to wonder if the drug is still of the same form and effect. This is where patients should be re-assured that they are getting the real thing but at discount prices (I hope) and to allay unnecessary fear from arising in them.
How much information?
As I mentioned earlier a little knowledge is a dangerous thing and therefore as I venture into a really dangerous area and perhaps as a blanket rule and to make it easier for myself, I would say information given must be adequate. It must be adequate enough for consumers to use it to make an informed decision and certainly this would vary from case to case and perhaps even consumer to consumer but may I suggest that it is vital that any consumer who feels that the information given is insufficient must have a known avenue for enquiry and clarification from the medical fraternity. Such an avenue must be easily accessible and user friendly.
Role of the media
Certainly the media plays a very critical role in the dissemination of information to the consuming public. By and large, we believe that we have a responsible media in Singapore but sometimes due to inadvertence oversight could be and as stated in the synopsis given result in "inaccurate" or incomplete reporting or transmission and information without scientific foundation (misinformation).
In this respect, we would urge the media to use specialised reporters who are familiar with medical practices to handle such reporting. Reporters should be encouraged to probe further into information given and verify thoroughly such information with responsible bodies like the Ministry of Health and even World Health Organisation (WHO), US Food and Drug Administration (FDA) and to present as complete a picture as possible on the matter.
As far as possible, the same reporters should follow up on the same stories which they spun off so that there is a consistent line of thought presented and reporters will get more familiar with the subject which can be technical in nature. As for private means of dissemination like web sites and medical newsletters created and issued by medical professionals, they should be subject to verification and scrutiny by the Medical Society.
Role of the medical professionals
Whilst it may not be possible to monitor every aspect of clinical practices, it is important that the SMA takes the lead to ensure that important medical news be disseminated through itself rather than through individual doctors. Such would include negative news and downside for medicines and treatments which may not be accepted as orthodox as yet.
In addition, scrutiny should be made by the SMA on in-house journals of practitioners and websites maintained by practitioners and where patients can freely access information on medical claims, products and treatments such as the ATC treatment. Whilst it is fair to say that most doctors who are professionals do not need monitoring, there are the odd black sheep who need the sword of Damocles to hang above them and keep themselves on tract.
What has been given today I trust will be some food for thought to the medical professionals and the media as to the consumers perspective of their role and may serve as a platform for them to work in tandem to ensure that information is readily available for consumers. It is when consumers are adequately kept informed that important health decisions can be made where such information really lies in the hands of the medical profession and the media. Thus as consumers, we can only ask that we are put in PACE with the profession and through the mass media diligence and the guidelines outlined earlier.