SINGAPORE: Sending all patients for detailed diagnostic tests in order to avoid misdiagnosing rare medical conditions is a defensive medicine practice which “deviates from good clinical practice”, Senior Minister of State for Health Lam Pin Min said on Tuesday (Aug 1).
Speaking in Parliament in response to questions from MPs, he said the Health Ministry (MOH) does not advocate doctors to do so, adding that it will just unnecessarily increase healthcare costs.
His response comes in light of a recent three-month suspension of a senior paediatrician who failed to diagnose and treat Kawasaki Disease in a one-year-old boy. The childhood disorder, which is characterised by the inflammation of blood vessels, can lead to severe cardiac complications if left untreated.
Dr Lam said Kawasaki Disease has an incidence of about 32.5 per 100,000 children below five years annually. KKH and NUHS see about 160 to 190 cases of the disorder per year.
However, it is “neither possible nor practical” for MOH to issue guidelines for all rare diseases, and doctors would have to exercise their clinical judgment in such situations, he said.
Clinical judgment is dependent on the seniority of the doctor, area of practice and experience, clinical presentation of each patient and the facts and circumstances surrounding each case, he added.
He said that doctors are expected to exercise good clinical judgment to manage patients accordingly. “For complex cases or for which the treating doctors are unsure, they can also discuss with other colleagues on the most appropriate management of the case,” he said.
“Medical knowledge is constantly evolving. It is important for doctors to keep abreast of medical knowledge and international guidelines based on the recommendation of medical experts.”
In response to a supplementary question over the case by MP Lim Wee Kiak, Dr Lam said he understands the concern of many doctors over the verdict of the case. But he stressed that it is important for doctors to have an “enhanced awareness” that should the patient develop any other symptoms or signs that point towards Kawasaki Disease, further investigation would be warranted.
“My advice to doctors is to stay calm and not over-react, and secondly, to read and understand the proceedings of the disciplinary tribunal, and appreciate the rationale and considerations of the judgment,” he said.
"Very often, when doctors read the headlines they will jump to a conclusion that if (they) miss a fever and therefore miss Kawasaki Disease, (they’ll) be suspended for three months, and that is actually not the case.”