Irish doctor with too many thoughts, too little time and a blog that's supposed to check in on reality.

Friday, March 31, 2006

Medical Council – How to respond to Scandal

Yesterday Dr John Hillery, chair of the medical council, said that the existing system for the regulation of doctors is an "archaic, dysfunctional and legally confrontational" one that does not work.
Despite welcoming the new legislation designed to update the Medical Practioners Act, Hillery went on to say - "I am not convinced that we all, doctors and patients, would be better served by State-run medical regulation. If such a State system is to be enacted it will need to be properly thought out and debated to the advantage of the patient."
He added: "I believe a professionally led regulation with a major input from non-doctors is best for patients. . . . A modern system of self-regulation has not been tried in Ireland. I believe the public deserve that. I ask for proper self-regulation, proactive and accountable. It deserves a trial."

I tend to agree with him. I don’t think a greater number of lay people on the medical council will ensure that we will never face another Neary. I don’t think that a greater number of lay people will contribute anything to practice guidelines when they do not have experience or knowledge of evidence based best practice.
The ability to make a complaint against a colleague is very difficult in the Irish hospital climate, especially against a senior one. How will more lay members on the Medical Council solve that issue?
How will more lay members make the complaints procedure better?
For example, if a woman made a complaint against a dermatologist to the Medical Council who expected her to take off all her clothes – would the majority of lay people think this was a bad thing? Unprofessional? Possible sexual harassment?
Doctors on the other hand would find this perfectly acceptable – dermatologists are concerned with the organ of the skin, and therefore must inspect all of it to decide on diagnosis and treatment.
A few months ago, Irish Times journalist Mary Raftery wrote about her experience as a lay member of the Dental Council.
I agree with her conclusions. (I’ll reproduce a good bit as it’s subs only!)While there is a role here for non-medical people, particularly in ensuring complete transparency, this process is more appropriately driven by doctors themselves. Lay people, by definition, lack the detailed knowledge necessary to judge the increasingly specialised nature of medical practice…….
It is merely to point out that it has been my direct experience that the influence of lay people, serving in a voluntary capacity in complex areas of which they have no expert knowledge, is in danger of being seriously exaggerated……..
It is simply not enough to throw a few more lay volunteers on to a medical council board.
This kind of tinkering around the edges of a system which is fundamentally flawed will do nothing to restore our seriously shaken confidence in the medical profession. Neither will it provide an adequate remedy for those who are damaged by doctors' errors.
But it seems that this is all we are going to get. Mary Harney described herself during the week as a fan of self-regulation. She is, however, part of a Government which is, entirely correctly, in the process of removing the privilege of self- regulation from both lawyers and gardaí.
This leaves the medical profession as the last major bastion where professionals are safe from outsider interference and control.
It is impossible to fathom how, in the wake of the Lourdes hospital scandal, Mary Harney could be such a fan of this.
Rafferty draws attention to the New Zealand system, which sounds more sensible - New Zealand, for instance, has split the two strands mentioned above. The business of clinical audit and the monitoring of standards and training is left to the profession, under the aegis of its medical council, which remains doctor-dominated. However, the investigation of complaints and concerns was removed from the council in 1994. It is now the responsibility of the Health and Disability Commissioner. His office is wholly independent and is staffed by professional investigators who are not doctors, but can call on specialist knowledge as required.


Blogger Justine said...

I like the New Zealand approach. I'm sure it has it's own flaws but it's much better than allowing Doctors to investigate complaints against other Doctors without oversight. Not quite as much of a cabal as the legal profession it seems. I have heard that no barrister has ever been struck off for misconduct in the history of the Irish legal profession. Whether this is true or not I do not know but certainly I have never heard of any case in which a barrister was struck off. In fact I have never heard of any incident where a barrister was seriously reprimanded or suspended from membership of the law library.

May 16, 2006 12:47 a.m.  

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