MOH has received feedback regarding the excessive issuance of MCs following outpatient medical service consultations, particularly teleconsultations. - PHOTO: ST FILE
SINGAPORE (The Straits Times/ANN): Don’t feel like going to work or school? Just do a teleconsultation and get a medical chit to go on sick leave for the day.
The Ministry of Health (MOH) fears that too many people are doing just that – and that doctors are acceding to such requests. It is now seeking feedback from doctors on tightening the rules on issuing medical certificates (MCs).
In a circular sent to doctors on April 22 reminding them of their obligations, MOH also sought their feedback on a proposal to amend the Healthcare Services Act to tighten the conditions for issuing MCs.
“(An MC) must be made in the context of an existing patient-doctor relationship and is premised on the duty of care the doctor owes the patient arising from this patient-doctor relationship,” according to the circular seen by The Straits Times.
MOH said that it has received feedback from various employers and government agencies regarding the excessive issuance of MCs following outpatient medical service consultations, particularly teleconsultations.
Among the allegations from the feedback it received are that some MCs were given for non-medical reasons. It said: “MCs were issued when patients mentioned that they had just wanted a certification to skip work or school, but they were not sick.”
It also highlighted another allegation that MCs were repeatedly issued to the same patients without referring them for physical consultations for further assessments or follow-up to check if they were indeed unwell. MOH called this “malingering and abusing medical leave privileges”.
The feedback it received also alleged that MCs were issued without proper clinical assessment and follow-up.
The circular, in explaining this allegation, said: “MCs were issued solely based on patients’ self-reported reasons for consultation that they had input into the teleconsultation platform or application, without any proper assessment by a medical practitioner to determine if there were indeed any underlying health conditions which warranted the issuance of the MCs.”
The circular quoted the Singapore Medical Council’s (SMC) Ethical Code and Ethical Guidelines, which state that “medical certificates must be issued to patients only on proper medical grounds arrived at through good clinical assessment”.
Signed jointly by Professor Kenneth Mak, director-general of health at MOH, and Professor Chee Yam Cheng, SMC’s president, the circular said: “In other words, the issuance of an MC under a particular circumstance is not a standalone activity that can be divorced from, but is instead reflective of, the duty and standard of care that doctors must uphold in their management of patients.”
It added that the issuing of MCs should also not be influenced by “extraneous considerations” such as who pays, employer preferences or benefits to the patient, noting that MCs are medico-legal documents that carry professional and legal implications.
Teleconsultation services are provided by both the public and private sectors. There are also several companies that specialise in online consultations, with charges starting from as low as $8 for a consultation without medication. These services have been regulated under the Healthcare Services Act since June 26, 2023.
According to the Healthcare Services (Outpatient Medical Service) Regulations, “a licensee must not provide an outpatient medical service by remote provision to a first-time patient”. It defines “first-time patient” as one who has not received an outpatient medical service from the licensee.
MOH also asked doctors for their take on its proposal to amend the Healthcare Services Act in order to tighten the conditions under which MCs can be issued.
Among the proposed amendments is a requirement that every MC issued for a patient must include the name and medical registration number of the issuing medical practitioner.
Another is that the doctor or dentist must have provided medical or dental care to the patient in order to issue an MC.
The ministry said it may conduct inspections or audits, or request the relevant procedures and policies with regard to the remote provision of outpatient medical services, and doctors who fail to adhere to the SMC’s ethical code and guidelines may be referred to the professional watchdog for further action.
Licensees of outpatient medical services that breach the rules may be fined, or have their licences suspended or revoked.
One provider of online consultation services, Reallysick.sg, which is part of See-Dr, said the proposed amendment will not affect its operations.
Its clinical governance officer, Dr Ang Kai Kok, told ST: “We have noted the contents of the circular and have forwarded the circular to all our doctors as a reminder. Our doctors do not provide MCs for non-medical reasons. As these are against SMC/MOH guidelines, our management will take action against errant doctors.” - The Straits Times/ANN
