Madam, - On Tuesday night last, Vincent Browne (RTÉ Radio 1) discussed issues surrounding the case of Dr Michael Neary, former obstetrician at Our Lady of Lourdes Hospital, Drogheda. A guest on the programme, Dr Peter Boylan, obstetrician, revealed that he and other obstetricians routinely give differential treatment to public and private patients in their care.
It was revealed that consultant obstetricians do not remain in attendance during normal births involving public patients (this care being devolved to the midwife), whereas the consultant does remain in attendance for private patients.
In response to questions from Mr Browne, who was evidently concerned that this practice implied inferior care for public patients, Dr Boylan was adamant that public and private patients receive the same quality of care.
Dr. Boylan explained that private patients "contract with" the obstetrician to attend the birth, but that attendance of this kind is entirely unnecessary for normal births. He further explained that the consultant would always attend both public and private patients whenever the birth presented complications. Mr Browne asked why it was not possible for obstetricians to attend all births. Dr Boylan replied that this would represent a "monumental waste of money", and repeated his claim that it was entirely unnecessary under normal circumstances for the consultant to attend the birth.
A central tenet of ethical practice is to not dispense useless treatment. If we are to believe Dr Boylan, a substantial element of the care dispensed by consultant obstetricians to private patients is useless. If it is not useless, then Mr Browne was correct in insinuating that public patients receive inferior care. Furthermore, the Medical Council requires that patients be "as fully informed as possible". Consequently, we are compelled to ask whether it is routine practice for private patients experiencing a normal birth to be informed that an element of the care for which a fee is paid is known to be useless. Again, if it is not useless, is it routine for public patients to be informed that they may expect an inferior service?
The Michael Neary case has unearthed malpractice of the most egregious kind. One good that might emerge against the wider backdrop of human devastation revealed by the Neary case is the possibility of improved ethical standards in relation to the everyday practice of medicine. Dr Boylan's remarks show that a lot of ground remains to be covered in this regard. - Yours, etc,
Prof JACK E JAMES, Department of Psychology, National University of Ireland, Galway.