Health expert calls for doctors to assess peers

Doctors’ competence should be continually assessed by their peers to minimise risks to patients, one of the country’s chief health experts said today.

Doctors’ competence should be continually assessed by their peers to minimise risks to patients, one of the country’s chief health experts said today.

Dr John Hillery, president of the Medical Council, told a conference in Dublin that rather than waiting for them to do harm medics should prove they are fit to practise.

But he warned regulation was only one form of guarantee.

“The public want safe services in safe settings from safe staff. For such safety, as with the airline industry, many processes must be in place. The regulation of the doctor is only one,” Dr Hillery said.

“Other clinical staff must be demonstrating competence, as must administrators and the settings within which health services are delivered.”

Dr Hillery warned a debate on regulation of doctors should focus on the most effective methods of assessment rather than who would make up the next Medical Council board.

In the wake of the damning Lourdes Inquiry report which documented the catalogue of savage mistreatment by Dr Michael Neary, the Royal College of Surgeons Ireland carried out a survey of public attitudes to the regulation of doctors.

Some 40% of respondents favoured continued self-regulation with more members of the public on the Medical Council, 42% favoured state regulation with equal members of the profession and the public and 9% favoured state regulation with few or no doctors involved.

But Dr Hillery warned this may deflect away from the real needs.

“While it may be a clumsy analogy, the one of cars is illustrative. All cars must have regular tests to ensure they are safe for the road. This is done on cars that seem to be functioning perfectly as well as those that seem to be having problems,” Dr Hillery said.

“The current process that regulated doctors could be described as being like an NCT that is only done on cars that have fallen apart on the M50 causing a major accident but cannot be done on cars that show signs of wear and malfunction but continue to move.

“The NCT is done on cars whether there are problems or not, surely regulation of doctors should have processes that act in the same way and allow all doctors to manifest their competence rather than waiting for a doctor to do harm.”

Dr Hillery revealed the Medical Council, which regulates the profession, had proposed such a process but new legislation was required to implement it.

The proposals included greatly increased lay representation to at least 40% of the Council membership, combined with a system whereby doctors prove they are healthy and competent.

Dr Hillery said: “The proposed processes will manage risk in a way that promotes good practice, allows the public to make informed decisions on what doctor they attend and deals with incompetent or misbehaving doctors before they cause harm.

“The debate should be on achieving this aim and not solely on the relative numbers of members of the future Medical Council.”

He added: “There are points for and against ending self-regulation by having more non-doctors than doctors on the regulator. I believe that a major change would damage the medical profession’s belief that it owns the standards of the profession and the duty to defend these.

“I think this would be bad for patients and medical practice. This debate must be part of a larger debate on the regulatory process and how it is resourced and most importantly on how the health services can be safe and productive for patients.”

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