It has been a week which has seen a succession of deeply disturbing reports about medical practice in this State. An obstetrician in one hospital and two surgeons in another clearly have questions to answer about their professional standards. It appears that a large number of patients have been been subjected to needless physical pain and needless emotional trauma.
In the Drogheda case, a doctor was allowed to perform an abnormally large number of hysterectomies over a three year period without attracting concern. In one case, a 20-year old woman will never have children as a result of a caesarean hysterectomy, which was regarded as unnecessary by an external report. In the other case a surgeon, who had already been investigated and not sanctioned by his own colleagues, was sharply criticised by an external inquiry. A British-based consultant, in reviewing a number of cases, including two in which patients died, concluded that one of the deaths "need not have happened" and that the other followed poor decision-making.
There are disturbing strands running through both cases. The consultants in question do not appear to have been subject to an adequate review system by their peers. Their cases attracted attention only because of the vigilance and initiative of individual members of staff and/or management. In both cases, external reviews by British-based experts were deemed necessary. There was, to employ the term used by the Minister for Health, Mr Cowen, last night, a great deal of "hidden medicine"
It is important in all of this to place this week's revelations in this newspaper in perspective. Standards in the medical profession in this State are, by common consent, very high. But this does not obviate the need for new procedures which would ensure higher standards and provide the necessary safeguards for the public. A situation in which a consultant is allowed to perform an abnormally high number of young hysterectomies - in some cases removing their ovaries - without apparently being called to account - warrants the most serious attention. It is difficult to envisage such a scandal developing in the US and (since the infamous Bristol case) in Britain, where professional committees in hospitals routinely assess surgical procedures and where `league tables' on hospitals are available to assist the public.
But there is also the wider question of how to ensure that doctors continue their professional development long after the completion of training. In the past week, the Medical Council has circulated all registered doctors with a discussion document on new competence assurance structures. Each doctor entered on a Specialist register would risk losing this unless he/she completed an agreed model of continuing medical education. These are the kind of ideas which could usefully be introduced but - given the issues of public safety involved - it is also clear that Government should be much more pro-active. The Minister for Health, Mr Cowen, is right when he says that the medical profession must become much more transparent if it wants to continue to be self-regulating.