There is much in the draft Medical Practitioners Bill which is of concern to doctors and it merits close study by all those concerned with the future of medical care in Ireland, writes Dr John Hillery
Some of the coverage of the recent draft Medical Practitioners Bill seems to be based on the assumption that the motivations of those who enter the medical profession are base and that the actions of doctors need scrutiny befitting such base motives.
Although we have had examples in Ireland of harm done and of actions that indicate a falling from the high standards expected of doctors, we have no evidence that these are in any way representative of the profession as a whole. A recent survey carried out on behalf of the Medical Council indicated that the majority of those contacted were not dissatisfied with their doctor.
For many years now, my predecessors and I have asked for a change in the way doctors are regulated. The current system is flawed and has failed patients, doctors and the reputation of the profession. It does not allow assessment of doctors except where harm has occurred. Irish doctors have not been allowed to regulate themselves in an appropriate way. Judge Maureen Harding Clarke's report into the activities at the Lourdes hospital reiterated this and backed our calls for change.
The Tánaiste has now produced a draft Medical Practitioners Bill which is multi-layered and which will introduce far-reaching changes to the way the medical profession in Ireland is regulated. These include the minister of the day having the option of making appointments to the council to ensure a majority of non-doctors on it. The number of members to be elected by the medical profession will be decreased. The number of non-doctors will rise from the current four out of 25 to at least 10 and possibly 13. The next council will be accountable to the Oireachtas and the minister of the day in many ways that may lead the medical profession to believe that its independence has been ended.
In a recent Irish Times opinion piece Mary Raftery quoted numbers from the Medical Council's Fitness to Practise records of 2002 to illustrate a hypothesis that the council does not do its duty.
The numbers simply illustrate the fact that the current systems of complaint within the health services are not useful and the avenues open to the Medical Council for dealing with complaints are not satisfactory. The council admits the latter. Currently, complaints need to be such as to merit a full Fitness to Practise inquiry before the Fitness to Practise committee can process them beyond initial (albeit thorough) examination.
In a response to the survey already mentioned, a respondent expressing dissatisfaction with the process compared the option offered for pursuing their complaint to being like a "firing squad" for a minor misdemeanour.
Plans are under way for appropriate development of hierarchical complaints systems within the health services and the new system planned for the council will allow it to be part of this both in processing complaints appropriate to it and in directing those that are not appropriate elsewhere.
Though a committee with a medical majority will make the preliminary decision on where an initial complaint will go, the final decision will rest with the council. As stated, this will have, if not a majority of non-doctors, a substantial minority of non-doctors. The inquiry teams which hear and adjudicate on cases of professional misconduct will have a non-doctor majority. The decision on whether an inquiry into a doctor's conduct is held in public or in private will be made by the inquiry team in each case.
The draft Bill outlines support for the performance procedures proposed by the council. These will require that all doctors who have finished training demonstrate their competence on a regular basis. To stay registered for independent practice, doctors will have to meet certain standards. Each patient attending a doctor in independent practice (general practitioner, hospital consultant or occupational or public health specialist) will know that that doctor is currently competent. In her article, Mary Raftery asked why information gathered in these procedures is to be protected from scrutiny. This is to allow for honest reflective examination by individuals of their practice. If figures indicate a risk of patient harm, action will be taken. Action will be taken by a committee of council that has equal membership of doctors and non-doctors. This professional performance committee will be chaired by a non-doctor with a history of public service.
There is much in the proposed legislation therefore which is of concern to doctors, and it merits close and thoughtful study. It merits studied responses by everyone concerned with the future of medical care in Ireland. It would be a pity if people's reactions were informed solely by the writings of those who seem to see the "power" of doctors as one of the main threats to the success of the health service.
All health professionals, including administrators should, like doctors, be required to take part in continuing education and prove their competence on a regular basis. All sites where healthcare is to be delivered should have to be accredited in accordance with national standard criteria which are based on international standards.
Many non-medical scholars writing on medical practice and on medical regulation point to a key factor in the therapeutic relationship that is hard to measure but would be easy to damage by over-regulation.
The draft Bill seems to take such a risk into account while putting the interests of patients to the fore. The draft is available on the Department of Health and Children's website. I hope that it will be read and re-read and that as many informed opinions as possible will be heard before the final draft is signed into law.
Dr John Hillery is president of the Medical Council.