By Wong Chiang Yin
The central defining relationship in healthcare is that between the doctor and the patient. Regulatory efforts are aimed at safeguarding and strengthening this. And rightly so, because the ethical framework that underpins our work is founded upon a healthy doctor-patient relationship. In an environment where significant information asymmetry favors the doctor, the patient’s interests must not be compromised.
Brave New World
Many of the new players in the healthcare landscape are not regulated as healthcare entities. These include managed care companies, third-party administrators, medical concierge services, and even web-based companies that offer doctor-searching, doctor-ranking, and appointment-making services. On scrutiny, many of these may directly or indirectly encourage doctors to behave in ways that may be detrimental to the patient-doctor relationship.
These unregulated entities are lacunae in our regulatory framework. The doctor-centric regulatory approach needs to be replaced by a comprehensive schema that includes the other players that so heavily influence the professional services provided by the doctor. Regulating the doctor alone is no longer sufficient to protect the central relationship in healthcare.
Commentary
The traditional strategy to protecting patient interests has been to keep the focus on the doctor. Ethical codes, fees schedules, and various guidelines reinforce the doctor’s responsibility to uphold the propriety and sanctity of the doctor-patient interaction.
However, the doctor-patient relationship is not the only material relationship in the healthcare landscape these days. Healthcare has come to involve multiple inter-connected parties that interact with one another in various ways. Many other relationships vie with the doctor-patient one as these other parties influence and direct the provision of healthcare services, and they have the capacity to alter the nature of the doctor-patient interaction significantly. Just think of the patient who has to switch to a new panel doctor when his company health coverage policy changes.
Moreover, the new compact includes more than just the officially recognized players. The old information asymmetry has, to an extent, been disrupted by the advent of WebMD and Dr Google. These new-age doctors are additional participants who are not bound by the ethical code and who do not pay malpractice insurance.
A regulatory approach that is primarily doctor-centric ignores this new reality.
Dr Wong Chiang Yin is a public health specialist who was previously chief operating officer of two major public hospitals. He is a former president of the Singapore Medical Association and is part of the current elected council of the SMA and the Academy of Medicine.
The commentary and vignette were reproduced with permission from the book “Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.
