Koh Kah Soon said in a letter to Today newspaper that:
“No matter how renowned a surgeon is, no patient should be treated as a guinea pig, nor should important information regarding risks and potential side effects of any medical procedure be withheld from a patient who has placed her trust in the hands of her doctor.
Certain practices may seem inconvenient. But the life and well-being of a patient should never be compromised for the sake of expediency.”
Well said. Let’s have some applause. But while all these ideals look good on paper, what does it actually look like on the ground when put into practice? Mr Koh seems to have a rather simplistic view of cases where patients challenge their doctors on informed consent. Is it so simple to tell right or wrong? Let me give a few classic examples.
A middle-aged gentleman who spoke reasonably good English asked me to fill up a badly decayed tooth. I checked it and found it to be non-vital. I informed the patient of the possible consequences of filling up a dead tooth. I gave him some better and safer options like root canal followed by crowning, but the patient was schocked by the costs involved. In the end, he insisted on filling the tooth.
A few days later, he turned up at my clinic, screaming at me for causing him so much pain. I reminded him of what I said to him before, but he instead of speaking in good English this time, he spoke in Hokkien and pretended not to understand anything I told him a few days earlier.
A Malaysian girl asked me to extract her broken front teeth and replace them with dentures. I discouraged her, warning her that dentures are unccomfortable. I recommended root canal followed by crowning. She insisted on extractions. A week after her dentures were issued, she complained that they were very uncomfortable. I tried to be sensitive with the “I told you so”, but she claimed that I didn’t manage to inform or illustrate to her how uncomfortable her dentures were going to be and if she knew it was this uncomfortable, she would never have asked for her teeth to be extracted.
A male patient had to go on a date and he wanted his missing front tooth fixed fast. Not wanting to take advantage of the situation, I charged him a nominal rate for his temporary bridge which I built up for him within an hour. I asked him to come back for his permanent bridge, but he disappeared, only to reappear very angry, complaining about his broken temporary bridge. The quotation for his permanent bridge, records of him failed appointments are all there, but it didn’t even make him feel guilty about his outburst.
What about the numerous half-done root canals? Once there is no pain, they don’t turn up to complete the procedure and when complications arise later, they either have genuinely forgotten about it, or they claim that they didn’t get enough information from the dentist at the beginning.
Mr Koh should realise that when patients complain that their doctors did not explain adequately about possible complications, it’s not always a clearcut case of the doctor not obtaining informed consent. It may well be a case of the patient acting blur or changing his mind. Mr Koh should also entertain the possibility that there may well be more patients who act blur than doctors/dentists or other healthcare professionals who experiment on their patients without informed consent.
