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Singapore to review rules in response to alleged excessive issuance of MCs via teleconsultations

Singapore to review rules in response to alleged excessive issuance of MCs via teleconsultations

Feedback received alleged that MCs were issued without proper clinical assessments and follow-ups – solely based on patients’ self-reported reasons, according to the Ministry of Health and Singapore Medical Council.

The Ministry of Health (MOH) and Singapore Medical Council have reminded all registered medical practitioners to be mindful of the obligations relating to the issuance of medical certificates (MCs) found in the Singapore Medical Council Ethical Code and Ethical Guidelines 2016 Edition (SMC ECEG 2016).

This also extends to all Outpatient Medical Service (OMS) licensees and their obligations under the Healthcare Services Act (HCSA) for the provision of OMS via remote mode of service delivery.

This reminder follows feedback received on the issuance of MCs. As shared, various employers and government agencies have noted excessive issuance of MCs following Outpatient Medical Service (OMS) consultations, particularly in the context of the remote provision of OMS — i.e., teleconsultations.

The feedback alleged that MCs were issued:

  • Without proper clinical assessments and follow-ups – 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;
  • For non-medical reasons – MCs were issued when patients mentioned that they had just wanted a certification to skip work or school, but they were not sick; and
  • For the purposes of malingering and abusing medical leave privileges – MCs were repeatedly issued to the same patients without referring them for physical consultations for further assessments or follow-ups to check if they were indeed unwell.

In response, MOH intends to impose a requirement on all licensees to ensure that every MC issued for a patient must include the name and MCR number of the issuing medical practitioner. In other words, the onus is also on the licensee to ensure it puts in place appropriate processes and protocols for the medical practitioners to ensure that MCs issued contain their names and MCR numbers, such as through training or system specifications when issuing the MCs.

As MOH reminds, any licensees found advertising or allowing the practice that the issuance of MCs under their approved services could be “anonymised” will be in breach of this proposed requirement.

A breach of the Healthcare Services (General) Regulations and Healthcare Services (OMS) Regulations may result in regulatory actions being taken, including but not limited to:

  • suspension or revocation of the OMS licensee’s licence;
  • shortening the term of the OMS licensee’s licence;
  • a direction requiring the OMS licensee to rectify the contravention, or prevent a recurrence of the contravention, and/or
  • a direction requiring the OMS licensee to pay a financial penalty

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