MEDICAL MATTERS Dr Muiris HoustonA notable feature of the recent annual general meeting of the Irish Medical Organisation (IMO) was the general sense of siege felt by doctors. Long accustomed to being held in esteem by society, it seems that whatever the view of lay people, physicians no longer feel a sense of appreciation and professional worth.
A number of motions put to the conference illustrate this point. One presented by a number of hospital consultants and supported unanimously by the meeting read: "The IMO supports the primacy of the doctor in the clinical care of patients and calls on the Medical Council to protect standards of patient care by resisting attempts to deprofessionalise the practice of medicine in Ireland."
Another proposal on the role of the doctor to receive the support of the meeting was put forward by Dr Roisin Healy, consultant in accident and emergency medicine at Our Lady's Hospital for Sick Children, Crumlin, Dublin.
She spoke passionately of the need for the doctors' organisation to affirm "that the practice of the science and art of the diagnosis and treatment of human disease is the practice of the profession of medicine". The gist of her argument was that others who wished to practise in this way should enter the profession through either "physician assistant" or graduate medical school programmes. And she also called for those who practise medicine, while unqualified to do so, be required to carry the same level of malpractice insurance as doctors themselves.
Lurking behind these formal motions is a strong sense of frustration on the part of doctors in all branches of medicine. They perceive threats from nurse practitioners and others, who seek autonomy and the power to prescribe medicine. Doctors are fed up; as they see it, they are the only professionals who are fully accountable in the Republic's health service.
The visiting president-elect of the American Medical Association, J Edward Hill, reflected widely held fears when he quoted a recent cover headline from US News and World Report: "Who needs doctors? Your future physician might not be an MD - and you might be better off."
The honorary officers of the IMO and its chief executive touched on another sore point for doctors. George McNeice spoke of a worrying trend of increasing attacks on the advocacy rights of the medical profession. "The Irish Medical Organisation is determined to take a decisive initiative in the coming year to protect the advocacy rights of doctors generally, and 'whistleblowers' in particular."
He signalled that the organisation, in collaboration with the Irish Congress of Trade Unions, would pursue the introduction of legislation to protect health professionals who draw public attention to inadequate standards of patient care.
Dr Asam Ishtiaq, the newly elected president of the IMO, also spoke of a growing threat felt by doctors. "Our clinical independence and our role as advocates for our patients are under serious threat."
He said he wanted to dispel the myth that clinical independence meant that doctors were neither answerable nor accountable.
Dr Ishtiaq told the meeting that doctors were accountable for their actions through workplace clinical audits and quality assurance projects. In addition, they faced ready censure by the Medical Council and were under the constant threat of litigation.
Nor have the new healthcare structures, outlined in the 2004 Health Act, done anything to lessen doctors' fears. The meeting heard complaints that doctors no longer had professional representation within the new Health Service Executive. They are annoyed at what they perceive to be unilateral changes in disciplinary procedures. And gagging clauses in the new Health Act have added to concerns that the traditional role of doctors as advocates for their patients may become a thing of the past.
Unless doctors are free to voice their concerns regarding the standard of healthcare available to their patients, there is a real danger that standards will fall and patient care will be compromised.
Whatever faults society chooses to attach to the medical profession, it must at least acknowledge that medical care is based on the highest standards of scientific evidence. Were we to lose the vocal input of physicians, based on well-researched facts, who will stand up for patients and ensure they receive the best standard of care possible?
Dr Muiris Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets he cannot answer individual queries.