Following a story in the Straits Times (see earlier article) about a circular jointly issued by the Ministries of Health (MOH) and Manpower (MOM) reminding doctors about their ethical responsibility to issue appropriate medical leave, a hand surgeon affiliated with Gleneagles Hospital wrote to the newspaper’s forum with his point of view.

Dr Andrew Yam Kean Tuck said that about a third of his patients “are workers who have encountered industrial accidents”, most with “minor injuries involving just one fingertip or a finger”, but “many continue to demand medical leave for weeks or months”.

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Further down in his letter (published 29 October 2018), he turns to ‘light duties’, a status issued in lieu of medical leave. In his letter, he referred to the circular, pointing out that according to MOM and MOH, “the onus is on the doctor to ensure that suitable light duties are available at the workplace before putting a worker on light duties.” His reading of the circular appears to be correct.

However, Yam disputes that the onus should be on doctors to do so. He writes:

… now we are forced to issue [medical leave] for any worker who claims he cannot return to light duties, even if his employers say these are available, as it is impossible for us to verify this.

He adds, “Many of these workers are malingering” with no further evidence (other than that the employers are insisting that light duties are available, something which he says doctors cannot verify) and accuses NGOs of “unwittingly aiding and abetting malingerers”.

He makes the point that

Doctors are not site inspectors.

Their role should be to only specify what duties are suitable.

It is the employers’ responsibility to provide such duties or to tell the doctor they are not available, failing which, they — not the doctor –should be brought to task if the worker lodges a complaint of insufficient medical leave.

On the surface, it is a valid point, but he seems to be using this point to reject the responsibility of a doctor to even enquire with the employer exactly what duties are available at the workplace and make a reasonable assessment whether the employer has fully understood the medical requirement. In TWC2’s opinion, such a “washing of the hands” does not meet the standard of due diligence.

However, he also states that “errant doctors” colluding with employers should be harshly dealt with, a point with which we fully agree.

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TWC2’s response was published on 1 November 2018 in the forum pages of the Straits Times.

We first wanted to reject his uncalled-for accusation that NGOs like us abet malingers. We wrote that

… we see over a thousand cases of industrial accidents annually, many of which come through our free meals programme for destitute workers.

This food programme has sometimes come close to running out of money to continue operations. In these circumstances we definitely are not interested in devoting scarce resources to support malingering workers.

We also pointed out that the question of insufficient medical leave, in the case of any particular worker, is not subjectively determined by us but based on the discrepancy between the medical leave issued by one doctor and another.

What we have often seen are cases where the first doctor, usually in a private clinic, prescribed one or two days’ medical leave, but when the patient sought a second opinion, usually at a public hospital, this was extended by several weeks.

We have also seen cases where the patient had to undergo surgery, but was given just one day’s medical leave after that. This suggests the possibility that the original short medical leave was determined by factors other than the medical condition.

TWC2 also pointed out that small construction companies rarely have work that is light in nature, and in light of this,

It may be more consistent with medical ethics to err on the side of caution and prescribe medical leave to ensure that patients in this industry get rest rather than rely on the word of employers.

Andrew Yam responded to TWC2’s letter two days later. It is here: In it he basically reiterates the point that once an employer declares that he has suitable light tasks for the injured worker, “the doctor is ethically obliged to certify them fit for light duties as specified instead of giving medical leave” — which sounds like a terribly distorted reading of ethics.

He also rejects our call to err on the side of caution.

There is also another letter on this subject by Jeffrey Law Lee Beng on 3 November 2018. It is here: