The final passage through the Dáil of the Medical Practitioners Bill, 2007 marks the beginning of a new regulatory framework for doctors. Reflecting the major societal changes of the last 30 years, the new Act will mean greater accountability, the formal assessment of competence to practise and the dilution of self-regulation by the medical profession.
Not unexpectedly, the changes have been opposed by some doctors. They object to a lay majority on the Medical Council; they see the new legislation as a threat to professional autonomy; and while largely welcoming the competence assurance aspect of the legislation, they worry that the significant resources required to ensure proper implementation will not be forthcoming.
The relationship between the public and the medical profession has changed in the last three decades linked to major social change and the increased democratisation of society. Deference, professional control and "doctor knows best" are no longer the basis for a healthy doctor-patient relationship. And there is certainly no place for the type of arrogance recently displayed by some consultant representatives.
A key question that must be addressed is what kind of relationship does society want to have with medicine? Do we want doctors to be father figures who adopt a paternalistic approach to our health? Or do we want doctors who are highly skilled technicians from whom we expect a specific service and no more? Are we better off becoming pure health consumers or do we want to be partners with doctors in healthcare?
Equally doctors must reconsider their role in a way that acknowledges our new meritocracy. They must seek out a new professionalism: one that acknowledges the autonomy of the patient; that recognises the importance of attitudes and behaviour; and one that values accountability and personal autonomy.
As society becomes more complex, people are less ready to defer to experts. With better education and ready access to medical information on the internet, people have more knowledge. Patients require a competent doctor who wears his expertise lightly and explains matters while discussing the merits and risks of a proposed course of action.
The key to any good relationship is trust. In recent years the collective trust of society in the medical profession has been tested. It is time for doctors to engage with representative patient groups and others to establish a modern relationship based on mutual respect and accountability.