Doctors told to shed 'siege mentality'

DOCTORS had adopted a "siege mentality" following recent medical controversies and needed to move away from that mind-set, the head of the Health Service Executive, Professor Brendan Drumm insisted yesterday.

Addressing a medical conference on competence assurance, Prof Drumm said he believed the medical profession was now willing to challenge the "batten-down-the-hatches" approach.

"I believe we get tainted as a profession, very negatively, often on the basis of individual occurrences and huge numbers of people then get drawn into the whole siege-type performance because of that.

"What we really need is leadership to take us forward and away from that kind of mentality," he said.

Also, up to now the whole area of collegiality had been the primary goal, which made it difficult to step outside the boundaries that the commitment brought with it.

"The tendency to isolate those who stepped outside the boundary must be challenged," he stressed.

Prof Drumm believes the process must start at medical school because students felt they could not be proper doctors if they did not feel unhappy or hard done-by.

"If we are building our sense of self-esteem on how tough our lives are, that, I think, is a very difficult place to move forward from," he said.

Prof Drumm said there was a need to get doctors to think they had entered a profession in which it was a privilege to serve people and gain a huge intimate insight into their lives.

The challenge of competency assurance would not be so great because it would be easier to get doctors to accept that responsibility came with the privilege of serving their communities.

But, he warned, if competency assurance came down to lists and lines and boxes to be ticked at a formal meeting, the challenge would be almost insurmountable.

Competence assurance should also be based on people's experience of doctors. "To do that we must bring people who are the receivers of our health care to the front-line."

And, he said, following the revelations about disgraced obstetrician Dr Michael Neary, there needed to be a process that allowed doctors to bring potential dangers in practices to the fore.

Chair of the Irish Patients Association Stephen McMahon said between 15 and 20 doctors would need to be involved in a competence assurance process every year.

Those doctors would be involved in around 200,000 consultations a year. "That, in our view, is a risk that needs to be curtailed," he said.

Assistant national director of quality, risk and customer care at the HSE's National Hospitals Office Dr Mary Hynes said the competence assurance process would have to be mandatory, allowing intervention quickly in respect of serious risk to patient safety. "In some cases that might mean removing the doctor from practice for a period," she said.