Public trust in the medical professions must be restored through openess and accountability, says Medical Council President.

March 11th 2006

The President of the Medical Council, Dr John Hillery, has said the Drogheda Hospital Report has damaged the trust of the public in the medical profession.  To restore trust, the profession will have to accept a new culture of openness and accountability, Dr Hillery said.

Speaking today (Saturday March 11th 2006) at the National Carers Conference in Tralee, Co Kerry, Dr Hillery said the Lourdes Hospital Report was horrifying.  "The challenge now for the medical profession is to admit that a terrible wrong was done to patients; to admit that doctors and others, who knew what was happening, did nothing to stop it; to admit that trust has been damaged; to acknowledge that trust is at the core of the therapeutic relationship and to outline and accept a new culture of openness and accountability."

Dr Hillery said the report showed there was a hierarchical structure in the maternity unit in Drogheda "that brooked no questioning of consultant activities even, amazingly, by other consultants.  It does not seem as if any doctor was aware or acted on their responsibilities as professionals."

He went on to say that the health system, if it is to enjoy the public’s confidence, must be open and support openness and accountability.  "As passengers, we want safe pilots, safe cabins, safe ground space and safe airspace.  Systems are in place to ensure this.  As patients we want safe doctors, safe allied staff, safe treatments and safe hospitals.  The systems to guarantee these are not in place yet."

The Medical Council President said the current system for regulating doctors was too reactive, accepts competence until proven wrong and it cannot intervene to promote competence.  "The regulation systems for other staff in the health service are either equally archaic as that for doctors, too informal to promote competence or non-existent."

Dr Hillery continued: "To go back to my air journey/illness journey analogy all the people of Ireland must have guarantees that doctors and other hospital staff are competent (Staff Competence Assurance). We must know that the hospital we attend or may have to attend is safe and competent to do what we need done for us or our relatives (Health Services Competence Assurance). We must be sure that the Irish system is keeping up with international benchmarks and ensuring that the resources match the needs for Staff Competence Assurance and Hospital Competence Assurance (Clinical Governance).

"There is a model for hospital accreditation in existence. It is thorough but it is voluntary. To give it mandatory powers may lead to some discomfort especially for those who campaign for the maintenance of a hospital that can do everything in every part of the country. All expert advice is that such an approach is not safe. There needs to be rationalisation and change to ensure good patient care. A robust accreditation system would promote this. The process is there as is the template for systems change. The public deserves such an honest and open approach to the accreditation and development of the place where they receive their health services.

"The country also needs a system of clinical governance to ensure the whole system is accountable and learns from experience. Such a system promotes the development of high standards by promoting national and international comparisons of practice and outcomes and promoting best practice. It will need both resources and a change in approach. Our current culture of adversarial medical litigation that severely punishes mistakes does not encourage learning. If people are harmed they deserve compensation but if a professional makes an honest mistake everyone should learn from it, not be afraid to discuss it.

"International figures suggest that 3% to 5% of doctors fall below acceptable standards of competence and behaviour. Therefore I believe that it is a patient’s right to know that the doctor they attend is competent. It can no longer be taken on trust.  The Medical Council has been developing a plan for structures that will require doctors to demonstrate that they are keeping up to date and assure patients that their doctor is up to date. These Competence Assurance Structures are already voluntarily in place at a certain level. Many are taking part. We need all doctors to take part and we need to have the power to use a hierarchy of approaches that will allow doctors to demonstrate that they are competent and allow doctors in trouble to be dealt with before they harm patients. This must be obligatory. The structures will involve non-doctors in a meaningful way and we need new laws to do this. The medical profession must continue to press for a new beginning in self-regulation. This must include a hierarchy of interventions to ensure that all practising doctors are competent and manifesting that competence to peers and non-doctors through critical review. The Tanaiste has acknowledged the need and it is important that the people of Ireland advocate for the laws to be introduced to deliver the system.

"It is vital that the other professionals involved develop similar robust structures. Judge Clark points out that administrators also must be involved in these processes and in maintaining and demonstrating competence. The profession is not the regulator, it is the individual members working with patients. It is there that the responsibility must be demonstrated. This applies to doctors and must also apply to other health professionals.

"The training of doctors must change. To get into medical school young people must be high academic achievers. Unfortunately the process thereafter does not always make best use of these attributes. The selection system also does not ensure that qualities beyond the academic are taken into account. International research shows that medical students with behavioural problems are more likely to become underperforming or dangerous doctors. The medical education system must acknowledge this and the selection processes, assessment processes and curriculum must deal with this. The recent Fotrell Report is the beginning, the medical schools are adapting, the pace of change must be rapid and the resources to change must be provided. In our work with the Medical schools the Council has been pushing for patient centred medical education. There must be more emphasis on community based teaching with increased use of General Practice Settings. There must be more teaching of the humanities and especially ethics. Inability to communicate with patients should militate against progression through medical school.  Medical students must acknowledge from the start that they have responsibilities. The Medical Council has proposed that they be registered and that they be accountable for their actions within an Ethical Code.

"One of the justifications for self-regulation of any profession is that the profession itself will set high standards and will take action against a member who does not live up to its standards. I believe that the next generation of doctors will wonder why their predecessors ever questioned the introduction of procedures which will protect patients and support doctors in manifesting high standards.

Ends

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