SINGAPORE – Dr Lim Lian Arn, an orthopaedic surgeon in private practice, made an honest, one-off mistake in not telling his patient about possible side-effects of a steroid injection.

Because of this, the Singapore Medical Council (SMC) brought him before a disciplinary tribunal, its lawyer asked for a five-month suspension, and his lawyer advised him to plead guilty and ask for a $100,000 fine.

The Court of Three Judges who reviewed the case and found Dr Lim innocent of wrongdoing, said: “It seems to have escaped all the parties that such a breach does not necessarily or inevitably lead to the conclusion that Dr Lim was guilty of professional misconduct.”

The judges – Sundaresh Menon, Andrew Phang and Judith Prakash – said it has been previously established that there are three stages to an inquiry of professional misconduct:

– Establish the applicable benchmark.

– Establish if there was a departure from this standard.

– Determine if the departure was sufficiently egregious to amount to professional misconduct.

In this case, the judges said the SMC, the doctor and the disciplinary tribunal stopped at stage two.

They said: “The underlying rationale for the three-stage inquiry is simple: Not every departure from the acceptable standards of conduct would necessarily amount to professional misconduct.”

There must be a threshold that separates relatively minor breaches and failures from more serious ones that demand disciplinary action. They said: “Were it otherwise, doctors would find it impossible to practise in a reasonable way.”

The court also clarified that giving patients an information dump is not “defensive medicine” and doctors who do that “will not avoid legal liability”.

Bombarding patients with information could confuse them even more and result in their being less able to give informed consent. The doctor would then have fallen short of his ethical obligation, they said.

The real meaning of defensive medicine, the judges said, is when a doctor takes a certain course of action to avoid legal liability rather than in the patient’s best interest.