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MOH Looking at Tightening Rules on MCs Issued After Cases of People Abusing It

2024-05-13 , 3:10 pm

We’ve all had those days where we just don’t feel like going to work or school.

Unlike employees at Pang Dong Lai who get 10 days of “unhappy leave“, Singaporeans don’t have the luxury of requesting for leave at their discretion.

While some of us just suck it up and power through at work or school, others have started using teleconsultations to get medical certificates (MCs) to wiggle their way out of commitments.

This has given rise to the term “ponstar”, a portmanteau word combining the Hokkien word “pon-tang (to skip an activity without any valid reason”, and “star”).

This word refers to those who often take MC to get out of work or school.

Three well-known apps for teleconsultations are MaNaDr, Doctor Anywhere, and MyHealth360.

Video consultations for these apps generally last under two minutes, with some even being less than a minute.

These consultations also generally cost under $20 to $30, making it affordable for most to get MCs any time they want.

“Excessive Issuance” of MCs

In a joint circular sent to doctors by the Ministry of Health (MOH) and the Singapore Medical Council (SMC), the ministry said on 22 April that it had received feedback from various employers and government agencies about the “excessive issuance” of MCs following outpatient medical service consultations, particularly teleconsultations.

According to the feedback, MCs were allegedly issued “solely based” on patients’ self-reported reasons for consultation, without proper clinical assessments and follow-ups to determine if there were any underlying medical conditions that warranted MCs.

“MCs were issued when patients mentioned that they had just wanted a certification to skip work or school, but they were not sick,” the circular read.

It also said MCs were also “repeatedly issued” to the same patients without referring them for physical consultations for further assessments or follow-ups to check if they were unwell, which the authorities said was “malingering and abusing medical leave privileges”.

“Get Your MC or Get a Refund”

MOH also said earlier this year that Medstar Medical Clinic & Surgery was under investigation for issuing MCs without any audio or video consultation on its telemedicine website, PocketCare.

The ministry said it had received information that PocketCare had been advertising on Instagram and its website that its patients would be able to obtain an MC in five minutes for $5.99 nett.

Investigations revealed that the clinic had been “providing consultation through a self-service text-based questionnaire” and that MCs were issued without any audio or video consultation with patients.

PocketCare’s website was also found to have featured claims that patients could “Get Your MC or Get a Refund”.

Dr Viknesh Shanmugam, the medical practitioner who issued the MCs following the consultations, has been referred to SMC for investigations into possible breaches of its Ethical Code and Ethical Guidelines.

MOH also issued a notice to Medstar Medical Clinic & Surgery, stating the Director-General of Health’s intention to take regulatory action in respect of its consultation, including a three-month suspension of its telemedicine services and the need to rectify its consultation services before it can be resumed.

Proper Assessment Is Required

According to the circular, teleconsultation services by registered practitioners have been regulated since 26 June 2023.

Regulations state that when teleconsulting with new patients, real-time, two-way interactive audio-visual communications like video consultations must be utilised.

“MCs should not be issued via teleconsultations to new patients solely based on the patients’ requests without proper assessment by a medical practitioner to determine if the issuance of the MCs is warranted,” said MOH and SMC.

The circular added that the recognition of MCs issued by registered medical practitioners is a “professional privilege”, pointing out that this shows the “high regard for and the trust” that society has placed in the profession.

Reader: What does this mean then? I can’t get MC anymore?

No, you’ll still be able to get MC because it would be unfair of MOH to suddenly say clinics can no longer issue MCs. However, MOH has proposed some amendments to the issuance of MCs.

Proposal For MCs To State Details Of The Issuing Medical Practitioner

The circular said that while the issuance of MCs is a “clinical decision”, it is “imperative” that the issuance of MCs adheres to the guidelines in SMC’s Ethical Code and Ethical Guidelines.

According to the guidelines, MCs “must be issued to patients only on proper medical grounds arrived at through good clinical assessment”, regardless of the mode of the consultation.

MOH also intends to impose a requirement on all licensees to ensure that every MC issued for a patient must include the name and medical council registration (MCR) number of the issuing medical practitioner.

This places a responsibility 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.”

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.

This requirement is still being discussed and the ministry is seeking feedback from doctors on it. Medical practitioners who would like to provide feedback on the new requirement can email in to [email protected] by 20 May 2024.

MOH may also conduct inspections, audits, or request for the relevant procedures and policies with regard to teleconsultations.

Those who breach the regulations may have their licences suspended, shortened or revoked. They may also be fined or issued a direction to rectify the breach and take steps to prevent it from occurring again.

Registered medical practitioners who are found to have failed to adhere to SMC’s Ethical Code and Ethical Guidelines may also be referred to the council for further action.

This does not directly reduce the number of MCs being issued, but some are saying that tighter regulations may cause doctors to be more stingy in issuing MCs.

While this may be inconvenient for “ponstars”, this does indeed spell great trouble for those who need MCs for legitimate reasons.

Being a Responsible Doctor

In the circular, MOH and SMC reminded all doctors to adhere to SMC’s Ethical Code and Ethical Guidelines. It said that doctors cannot consider extraneous factors when issuing MCs.

These factors include who pays for the consultation, what benefits the patients may receive, or what employers’ preferences may be.

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,” the circular read.

Unhappy Reactions From The Public

Unsurprisingly, the public is not happy with this news.

While there are a number of people who use MCs to get out of work or school when they just don’t feel like it, there is a considerable number of of people who need these MCs, such as those who are too ill to physically visit a doctor.

Another example would be those with little annual leave. All employees in Singapore all entitled to a minimum of seven days of annual leave per year, which most would consider pretty terrible.

For those with little annual leave, using it on their sick days isn’t really an option, hence they have to resort to taking MC. As such, the news of possibly tightening rules on MCs has not been well-received by those with little annual leave.

Others have also pointed out that those with mental health issues stand to suffer, and say that those suffering from work burnout or constant overtime may lose their only way of getting time to recover.

Bank of Singapore’s Workers Allegedly Abused Medical Benefits

Just about two weeks ago, it was reported that employees working at the Bank of Singapore had allegedly abused medical benefits.

No, they did not take MC every day.

They did, however, use the company’s medical claims on illegitimate items such as bird’s nest and skincare products, with some claiming up to $10,000 worth of items.

Investigations into the matter caused up to 40 employers to be fired, while others faced disciplinary outcomes such as bonus cuts and cancelled promotions.

Read all about it in this article here or watch the video below to find out what happened.