Sir, - According to recent reports, medical and surgical "royal colleges" are providing "expert" surgeons and obstetricians at the request of employers to assist in the investigation of Irish doctors accused of incompetence. This appears to be happening without the involvement of the Medical Council (charged with protecting the public interest) and with little evident legislative basis. The council has recently made proposals for regular re-accreditation of doctors to ensure they deserve to be retained on a new specialist register intended to guarantee the continuing competence of individual doctors. The council is frustrated in these aspirations by the failure, over many years, of the Department of Health to update the Medical Practitioners Act so as to put the new specialist register, the re-accreditation of doctors and supervision of sick doctors on a sound legal footing.
These are more than petty arguments between precious doctors and equally precious civil servants: they are matters which affect us all. Already, medical scandals in Britain have stretched the credibility of self-regulation by the medical profession there to breaking point. The British government has threatened to remove self-governance from the hands of the profession in the face of the apparent inability of the General Medical Council in the UK (on which the Irish Council is modelled) to act. This is likely to prove an empty threat: the competence of doctors can only properly be assessed, inter alia, by other doctors. At present an Irish citizen wishing to know if a doctor is competent has no reliable way of finding this out.
The delaying factor in putting all of this right is the Minister for Health and Children or, more correctly, successive Ministers. The proposals now being aired by the Medical Council are not original: they derive from EU law and already this country is about three years behind the United Kingdom in protecting the public from incompetent and sick doctors. Such protection depends eventually on a tripartite alliance between government, profession and employers. None of the three is competent to manage things on its own.
The public, egged on by the media, is coming to see medical colleges as cosy clubs with little private or public commitment to maintaining standards once a doctor has reached independent consultant status at about 32 years of age. The public may be right. What is needed now is a radical change of attitudes all round if ordinary people are to continue to have confidence in their doctors. The initiative here lies with government to empower the Medical Council to fulfil its mandate to protect the public interest. Continued delay will jeopardise the welfare of patients and further undermine public confidence in the medical profession. - Yours, etc., Prof T. J. Fahy,
MD, FRCPsych, FRCPI, Department of Psychiatry, National University of Ireland, Galway.