Clinical Governance and the Role of Law

Abstract

A series of scandals involving doctors in the UK had stoked public anger against the medical profession and challenged the traditional practice of self-regulation by the medical fraternity. The more prolific scandals include atrocities committed by Harold Shipman and the abysmal clinical care rendered by the Royal Bristol Infirmary. Subsequent public inquiries commissioned by the UK government unveiled startling facts about the medical profession and how doctors regulated their professional affairs. The Bristol Inquiry portrayed the medical profession as a community besieged by a hierarchical culture and weighed down by self-protectionism; when things went wrong for patients, doctors had a tendency to close ranks while the minority that perceived the problem was often cowered into silence by other senior colleagues. The Shipman Inquiry on the other hand, had exposed procedural flaws in the disciplinary process conducted by the medical profession¿s highest body, the General Medical Council (GMC). There should not be any reason to doubt clinical governance in Singapore continues to be based upon professional self-regulation. The handling of all matters pertaining to professional registration, practice standards and conduct, rests almost entirely on a core group of medical practitioners whose decisions are shielded from external scrutiny. Likewise, at the institutional level, clinical audit and quality assurance activities are monopolized by doctors who perform their duties behind closed doors. Unfortunately, the public¿s blind faith in the medical profession under this system of self-regulation has not necessarily always been reciprocated by an ethos of community service in the medical fraternity. The Ministry of Health¿s recent clampdown on dubious remedies propagated by aesthetic medicine practitioners is testimony to how self-regulation has undermined patients¿ interests. It is also overly simplistic to assume that doctors directly benefit from professional self-regulation for there is no shortage of case law on how the Singapore Medical Council had transgressed principles of justice during disciplinary proceedings. Law has always been a beacon of fairness in society. Thus, the way forward for clinical governance will be the implementation of statutory law reforms to instill greater transparency, accountability and representation in professional regulation. In the area of medical negligence, the Singapore courts should reconsider the merits of the Bolam principle. This is because in other common law countries, judicial activism has either narrowed the application of the Bolam test, or moved the adjudicative process away from the Bolam principle completely. Further, the Bolam principle is not reflective of how modern medicine has evolved over the last few decades. The time has come for judges to take on a more interventionist approach and not defer to medical expert opinion too readily.