On 17 September 2018, the Ministries of Health and Manpower jointly issued a circular to doctors reminding them to abide by guidelines laid out by the Singapore Medical Council (SMC) with reference to medical leave. The relevant guidelines cited were the 2016 Ethical Code and Ethical Guidelines (ECEG): Guideline B4(4) – Medical Certificates. The full circular can be seen at this link on MOM’s website.
It emphasised that “The key concern when an injured worker is made to return to work is the risk of aggravating the injuries and reducing his chance of full recovery”, and therefore “The number of days of MC should commensurate with the severity of the injury sustained by the workers.”
“MC” is used to mean medical leave certificates.
The trigger for issuing this circular was this: “MOM has received feedback that some errant employers influence medical practitioners to downplay
the severity of the injuries by issuing lesser number of days of MC or issuing light duties in lieu of MC against the interest of the injured worker. The employers do so to avoid reporting the accident to MOM or for the purpose of reducing compensation to the injured.”
On “light duties”, the ministries reminded doctors that they had a responsibility to ascertain whether there are indeed such tasks suitable for the worker to perform before prescribing this status in lieu of medical leave. The circular said:
In addition, light duties should be issued in the best interest of the worker, and only after taking into
consideration the following: –
a. The appropriate duties are indeed available at the injured’s workplace. This entails an understanding of the injured’s work environment, job duties and demands; and
b. Whether the injured’s incapacitated condition allow him to perform those duties without aggravating his injuries.
A doctor would later write to the Straits Times Forum arguing that medical practitioners should not have any responsibility to ascertain appropriateness of light duty. See this post.
The Straits Times had a story about this circular on 19 October 2018 “Doctors reminded to give injured workers the rest they need”. The story opened by stating that MOM is concerned about the matter and that “Since last year, it has referred three doctors to the Singapore Medical Council (SMC), the professional watchdog, which is investigating the cases.”
When the newspaper reached out to TWC2 for comment, we pointed out that a similar circular was issued in 2013, and as far as we could see, there had been no real improvement in doctors’ behaviour. Of course, not all doctors should be tarred with the same brush. Almost always, reports of insufficient medical leave or inappropriate referral to light duty come from workers who have been taken by their employers to private doctors paid by the same employers. We don’t see such reports related to doctors in public hospitals; and it is more than likely that the greater majority of doctors, even in private practice, would be beyond reproach.
Nonetheless, it is significant that MOM and MOH saw fit to re-issue the circular.
Incorporating our comments into its story, the Straits Times wrote:
However, neither the Transient Workers Count Too (TWC2) nor the Humanitarian Organisation for Migration Economics (Home) were impressed by the circular.
Both pointed out that a similar circular sent in 2013 has done little to improve the situation.
Mr Ethan Guo, general manager of TWC2, said: “If nothing has really improved since 2013, it is hard to be confident that this new circular would change anything either.”
The newspaper also reported that according to MOM and MOH, “while the number of such cases is small, they will report doctors suspected of issuing inappropriate medical certificates to the SMC for further investigation.”
The reporter also asked us if we had made complaints to MOM about doctors issuing too little medical leave. As far as we can recall, we haven’t done so, at least not for several years. Why not? Two reasons, mainly:
- We are not medical practitioners and we don’t feel we are in a position to judge in any particular case whether the MC days given were too little. All we can observe is that there is a pattern where, once a worker seeks a second opinion, he is given a lot more days. This strongly suggests that there are at least some cases of under-prescribing medical leave. But we cannot know with any professional certitude which cases these are. See Case Study below.
- In social work, we are guided by the primary concerns of our clients. Injured workers who come to TWC2 would typically have already made their own way to a public hospital and gotten extended medical leave. They might have been unhappy with the employer-designated doctor, but once they’ve been to a public hospital, the issue would be ‘water under the bridge’. They have far bigger problems to attend to — daily sustenance being one — than lodging complaints against doctors.
Under the law, workplace accidents that result in an employee being hospitalised for more than 24 hours, or given more than three days of medical leave must be reported to MOM. Employers who fail to report an accident can be fined up to $5,000 for the first offence, said the Straits Times. For subsequent offences, the penalty can be up to $10,000 and/or imprisonment for up to six months.
The Straits Times said that MOM would take action if it uncovers safety lapses or infringements such as failure to report accidents. However, in all these years, TWC2 has not seen the ministry take action against any employer for late reporting.
Sundram [not his real name] broke his left leg in early May 2018. He was standing on the back of a Malaysian lorry helping to unload cargo when the rotten floorboards gave way under him. His leg crashed through the wood and his tibia was fractured. He was taken to a private hospital the same evening and X-rayed. Then he was sent back to the company office where he spent the night in pain. The next morning, he was taken to a different private hospital and operated on. He was warded for a night.
On discharge, he was given four days of medical leave. This was followed by light duty. Seven weeks later, he made his own way to the emergency department of a public hospital, where the doctor there immediately put him back on medical leave.
The photo at left was taken seven weeks after the accident. We saw that his leg was still bandaged and somewhat swollen and he could only walk with difficulty. What light duty could he have performed during the six weeks prior?
At TWC2, we can have our suspicions about the appropriateness of light duty and the four days of MC but we are not in the best position to draw definitive conclusions.