ARE locally trained doctors guilty of 'a conspiracy of tolerance' when it comes to judging the professional behaviour of peers? Borrowing a phrase from a Dutch publication entitled Problem Doctors: A Conspiracy Of Silence, a recent study in the Singapore Academy of Medicine journal Annals concluded that these doctors' views on professional misconduct or ethical lapses were 'suggestive of a tacit norm of non-criticism, a conspiracy of tolerance'. It seems a harsh verdict, but also one that hints at redemption in the medical fraternity being ready to discuss the issue openly. It can be no less.

The report was forthright in comparing doctors who graduated from the National University of Singapore and those who trained in universities abroad. The comparison was unfavourable to the home-grown, but neither was there any attempt to explain or amplify the unflattering difference. It is nonetheless revealing that house officers educated here felt their professionalism training was inadequate. To its credit, NUS acted quickly. Last year, instead of offering it only in the last one or two years of a medical course, it incorporated medical ethics in all years of the five-year syllabus. The training is probably an important contribution, if not the most important, to understanding and upholding professional and ethical standards. It was no coincidence that foreign graduates, who all agreed their medical schools taught professionalism well, also were not prepared to be as lenient as their locally trained peers towards those guilty of misconduct.

Professionalism training should form an even more important part of the curriculum in Singapore medical schools, where students generally start their courses younger than elsewhere. Despite selection on the basis of non-academic criteria as well as grades, judging at interview whether candidates have the aptitude for doctoring is more difficult at an age when a career is usually yet to be decided. At the same time, the younger and more impressionable they are, the more effectively are they likely to absorb the ethical strictures of the profession.

Even if intake selection is sound, all medical training centres, including hospitals, need to attune faculty staff to inculcating norms of professional conduct besides imparting clinical skills. Professors have to take students and house officers beyond textbook learning. They have to conduct themselves as professional role models as well as teachers. An integrated professionalism programme can help close the gap in attitudes and perhaps behaviours between home-grown and foreign-trained doctors.

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