“Our lives begin to end the day we start to remain silent about the things that matter” – Martin Luther King
It is not surprising that the president of the Medical Council, Freddie Wood, finished a recent address at the annual Millin meeting of the Royal College of Surgeons in Ireland with this quote.
On the topic of surgical leadership and professionalism, Wood, himself a retired cardiothoracic surgeon, asked college members to commit to a system of clinical performance measurement that will underpin patient safety and safeguard public trust in surgeons.
This Medical Council has placed patient safety at the centre of its strategic goals. “Where I think this council can have the most impact is in our work in setting standards of medical education, training and continuing practice,” Wood says.
“All the international research shows that doctors who have issues at medical school are likely to continue with bad practices throughout their professional lives. If we can work to standardise the training experience for all doctors so that it is consistently high, we can make sure a reference for good practice is there throughout a doctor’s career.”
Regulation of the profession has increased hugely as a consequence of successive international and national medical care scandals, he notes, name-checking in particular the Harold Shipman affair, the Neary scandal and the hepatitis C inquiry.
“The Bristol inquiry into paediatric cardiac surgery in Bristol Royal Infirmary during the 1980s and 1990s changed forever the trust the public had in surgeons and surgery,” he adds.
Trust shaken
While public trust in the medical profession was undoubtedly shaken, “the Medical Council’s research shows year after year that doctors are the most trusted profession [by more than 90 per cent] in the country and the vast majority of patients are very satisfied with the care they receive from their doctor,” he says.
“As a regulator, our role is to help maintain that trust, by acting independently and in the best interests of the public. By doctors having a clear focus on outcomes and being honest with their patients, that trusted position can continue.”
Speaking of honesty, does he feel that when seeking patient consent, doctors should share their personal outcome statistics rather than generic ones? “I firmly believe that every doctor should know what they do, how much they do and how well they do it, in particular those who operate or perform procedures,” says Wood.
“As a patient, I’d want to know what the success rate of an operation of the particular surgeon or operator was before I gave consent and I think it should be every patient’s right.
“On the matter of consent,” he adds, “I am of the view that the surgeon performing the operation should obtain consent [in person], unless it is a lifesaving situation. I am also of the view the surgeon or operator should be considered competent to do the procedure or operation by their peers.”
At the launch of the council’s five-year strategy this year, Wood says a key issue to emerge from research and consultations was the need for leadership in putting agreed values for good professional practice consistently into action. His use of the word consistent is significant in the light of Savita Halappanavar and other cases.
Leaving Ireland
A recent trend is for young doctors in particular to leave Ireland in high numbers.
The exit rate of 25- to 29-year-old Irish-trained doctors grew from 6.4 per cent in 2012 to 7.9 per cent last year, according to the council's second annual Medical Workforce Intelligence Report.
An obvious question arises: is this because of working conditions or does it reflect dissatisfaction with the quality of postgraduate training?
Just published, the Medical Council's Your Training Counts is a study of the views of some 1,600 doctors registered under the regulatory body's trainee specialist division.
As well as looking at trainees’ opinion of the clinical learning environment in Ireland, it asked specifically about their preparedness for transitions, retention and career plans, and trainee perceptions of safety at clinical sites.
The results point to areas needing improvement. Some basic educational processes such as feedback and supervision are working less well than others.
“Weaknesses regarding patient handover need to be addressed, not just for the benefit of trainees but in the interest of patient safety,” the report states.
There is also a specific warning in the conclusion of “a need for healthcare organisations to address a number of inter-related issues regarding the governance and management of the clinical site – as a place for trainees to learn but also as a place for them to work and care for patients”.
Heartening
How does Wood respond to the findings?
“What is very heartening,” he says, “is that there is a focus on patient care and the majority of trainees are of the view that the quality of care provided is good or better. I think the key finding we’ll need to address is that there was a very wide variation in trainee views when it came to their training.
“What is coming out of the report is that there’s a definite need to make sure that the basics are in place, such as proper induction and giving feedback to trainees. Looking back over my 40-plus years in practice, I was unsurprised by a lot of the findings and the profession needs to reflect and look at making some cultural changes.”
Ultimately, when his term as president is over, his hope is that both the profession and the public will feel the Medical Council has acted as a true advocate in health.
Doctors’ perceptions of the Medical Council
“Many in the profession have accepted the changes consequent to the 2007 Medical Practitioners Act and realise that Ireland has to keep up with the rest of the world.
"However, many are bitter about fitness to practise inquiries being held in public and believe this is damaging, both professionally and personally, even if not found guilty. Both I and the council are concerned about this and have asked all postgraduate bodies to provide support." – Freddie Wood
