In his first major interview as Medical Council president, Dr John Hillery tells medical correspondent Dr Muiris Houston it must relate to patients better
Dr John Hillery has not been afforded a honeymoon period with which to ease himself into office. Within days, he was on the airways discussing Dr Pascal Carmody and William Porter and their promotion of photodynamic therapy for patients with terminal cancer. And last week, even before he chaired his first council meeting as president, the issue of who speaks to the public and the media on behalf of the Medical Council had to be tackled.
"Protecting patients has to be the first priority of the Medical Council. Our function is not to cover up for doctors. If you go to see someone for a certain procedure, they should be trained for that procedure," he says. "Looking at Dr Carmody, he should not have been in practice. But under the current Medical Practitioners Act, we cannot reach out to individuals like him.
"In Dr \ Neary's case (the former Drogheda-based obstetrician who was struck off the medical register last year for professional misconduct), you could argue that a system of audit and peer review would at least have given warning signs."
Hillery says he has looked for a meeting with the Minister for Health, Mr Martin, following the Carmody case "and on the foot of Porter, who of course we cannot go near at all because he is not a registered medical practitioner". Porter was a doctor in the US but essentially practised as an alternative practitioner when he came to the Republic. What can be done about people like him?
"Well, it is a problem. It is vital from the public interest that alternative practitioners be regulated in a formal way. The current Medical Practitioners Act does not contain a definition of 'the practice of medicine'. If the new Act contains this, it will be helpful in that if you have to be registered as a medical practitioner to do certain things to people, that would prevent some alternative practitioners from doing what they are doing."
Has he any insight into why a new Act has been so long emerging from the Department of Health despite repeated assurances from Mr Martin that it is about to be published? "I think it is simply a resource issue in the Department. The people there seem to understand the urgency and where we stand," he says. "But it would be helpful to see the heads of the new bill, at least that would give us something to respond to."
So, can the new Medical Council do any more to protect the public without a new Medical Practitioners Act? "We have talked to the lawyers about bringing in competence assurance structures without a new Act. In other countries, they carry out what they call a Level III assessment if a doctor contacts the authorities with concerns about a colleague.
"An in-practice assessment is carried out, with questionnaires sent to patients and staff. I have seen this in operation in British Columbia and Quebec - it is not fool-proof and it does require protection under the law. Such a system would allow us to get to the situation early, before it goes down the line."
Another Canadian influence is the practice in British Columbia of having information leaflets about its medical council freely available in doctors' surgeries and waiting rooms. "The Medical Council must be contactable and a leaflet like this would get us out there and let people know how issues are dealt with," Hillery says.
It bothers him, that, at present, people have to write the Medical Council a letter to initiate contact. "What happens to the person who cannot read or write?" It also concerns him, following the Carmody case, that people don't seem to be aware that they are entitled to ask about a doctor's training and expertise.
So are the public overly respectful of the title 'Dr'? "That and a fear of being exposed of not understanding what we say. People don't want to antagonise us. But there is also the trust issue, and we must be careful not to abuse it because it is central to the doctor-patient relationship and is still a large part of the therapeutic process."
How does he regard the British model of carrying out most fitness to practice inquiries in public? While emphasising his concern for doctors who are ultimately found not to have a case to answer, he wonders whether the societal need for openness outweighs any disadvantages for the profession.
"If we are putting patients first, then maybe it should be a choice that is offered to them. But before that huge change, I think we have to address the point that at present the Medical Council does not relate well enough to doctors and patients."
He would like to see the fitness to practice committee be able to give complainants a detailed explanation as to the outcome of any inquiry. "It is unsatisfactory for both patient and doctor just to send a letter saying 'there is no case to answer'."
On the topic of the council's ethical guide which is traditionally published at the end of each term of office, he feels there should be a rolling interaction with the issues of the day "and one that is evidence based. It should be a question of 'is there an issue we need fresh guidance on?'"
Hillery is a 1983 graduate of the Royal College of Surgeons in Ireland. A consultant psychiatrist with a special interest in the mental health needs of people with an intellectual disability, he is based at Stewart's Hospital, Palmerstown. His father, Patrick, was a GP in Co Clare before becoming a full-time politician and subsequently, President of Ireland. His mother, Maeve, was an anaesthetist who went on to train in paediatrics.
So what makes him a good doctor? "I sometimes wonder if I am," he says with a laugh, and then more seriously: "actually I keep asking myself am I a good doctor?"
An important influence was being brought up to consider that other people come first. His strengths? "I think I can relate to people and not patronise them. Also, I try to question the treatments I use." Weaknesses? "I think I can come across as a bit bossy and I can be a bit over eager to please everyone."
With both parents doctors, how much of an influence were they? "There was no pressure to go into medicine. When I was about 12, Dad and I discovered each other. I spent a lot of time with him going up and down to Clare. My mother and I are close - she has always kept interested in medicine. My sister had a terminal illness and died when she was 18 and I was 29, something that was bound to have an effect on you. And I also learnt from Dad the art of listening to people." Hillery says of the new Medical Council: "The issues now are broad ones, rather than new specifics. The main one we have to get right is how we relate to the public, otherwise the profession is going to suffer as well."