Prof Kieran Murphy, the president of the Medical Council, is keen for it to become more transparent and proactive
WITH UP to €1 billion being cut from health spending next year, patients are likely to have to endure longer waiting times to be seen as hospital inpatients and outpatients. Also, services in the community, such as home help hours, are likely to be trimmed further.
Many healthcare staff may be frustrated by the effects of cutbacks, but doctors have been warned they should not stand idly by.
Doctors have a responsibility to advocate for appropriate healthcare resources and facilities for their patients, says Prof Kieran Murphy, the president of the Medical Council. “The patient must come first. This supersedes a doctor’s responsibility to their employer,” he says.
Doctors’ obligations in this regard are set out clearly in the council’s ethical guide. But what is a doctor to do in certain situations? Take, for example that highlighted in the recent Hayes report into the failure by Tallaght hospital to process more than 3,000 GP referral letters over a prolonged period.
Consultant orthopaedic surgeons decided it would be “morally unacceptable” for them to see any more referrals when they couldn’t deal with the patients already on their waiting lists. This was due to the failure of hospital management to ring-fence beds for elective orthopaedic patients. Management was using their beds to clear trolleys out of the emergency department – described as “a political imperative” at the time.
The report said withholding services from one group, even for the best motives, raised important ethical issues that required careful consideration.
So could a doctor end up before a fitness to practise inquiry for failing to put patients on a waiting list, even if they had no prospect of being seen?
Or is it possible the doctor’s actions would be seen as justified because they were advocating on behalf of patients by trying to force hospital management to address ridiculously long waiting times?
Prof Murphy admits these are difficult situations but says the interests of patients have to be put before everything else. “If there is a conflict in the doctor’s mind, he needs to be guided by the principle that his actions should be dictated by what he feels are in the best interests of his patients,” he says.
“The doctor needs to take advice as to what course of action he should take . . . from the Medical Council and from his medical indemnity insurers.”
The Hayes report concluded that the policy adopted by the consultant orthopaedic surgeons in Tallaght was not in patients’ best interests because many of them, when seen in outpatients, did not require surgery and would have benefited simply from assessment.
Furthermore, with the advent of the National Treatment Purchase Fund, patients listed for surgery who had been waiting for long periods could have accessed surgery through this route once seen.
Prof Murphy, who is now halfway through his five-year term as Medical Council president, says the number of complaints to the council about doctors is increasing. At the beginning of this month the number of complaints received was higher than the total received last year.
He says there are many reasons for this. It is not that there are more problem doctors out there. Rather, there is a greater awareness of the Medical Council and what it does now that the majority of fitness to practise inquiries are held in public, following a change in the law.
In addition, the Medical Council now tries to be more open about what it does – it publishes minutes of meetings on its website, for example – and it has drawn up an easy-to-follow guide for patients on how to make complaints.
He says the council has been getting about 300 complaints a year about doctors. On average, 10 per cent proceed to fitness to practise inquiries.
All complaints are treated seriously, he says, including anonymous ones. The council itself can begin an inquiry without receiving a complaint from a third party – for example, if information comes to its attention about a doctor through the media.
In the past, when fitness to practise inquiries were held behind closed doors, there was often a perception that doctors against whom patients had lodged complaints were getting off scot free, with little information ever emerging on inquiry findings.
But Prof Murphy, a consultant psychiatrist at Beaumont Hospital and professor of psychiatry at the Royal College of Surgeons in Ireland, insists there is no evidence doctors are being dealt with more harshly as a result of inquiries being held in public. “I was on the last council also, so I can directly compare . . . and I would say there’s really no difference in terms of how doctors and patients are treated.”
In the past the Medical Council was perceived as a secretive and stuffy organisation, but Prof Murphy says it was not intentionally so. The legal framework it operated under before the change in the law meant it wasn’t as open as it would have wished. The new Medical Practitioners Act has changed that and the council now wants to engage proactively with the public and the profession.
“It’s very important that this happens because I think there has been a perception in the past that the Medical Council . . . was a club run by doctors for doctors,” he says. But, he stresses, things have changed. Ireland is now the only country in the world with a lay majority on its medical council.
The council is self-funded from annual fees paid by the more than 18,000 doctors on the medical register. Most pay €490 a year and this covers staff costs and legal bills, which are rising as a result of increased numbers of complaints being handled.
Meanwhile, Prof Murphy rejects suggestions the council bears significant responsibility for the current shortage of junior doctors due to changes in registration rules.
“It is largely due to the fact that doctors are voting with their feet. Their conditions of employment have changed. They are now seeing that they may be able to have a better quality of life abroad,” he says.
However, he says the council is working with the Health Service Executive (HSE) and the Department of Health to try to find solutions to the shortage that, unless addressed, could result in some smaller hospitals losing more services in January when junior doctors rotate posts again.
He confirmed that the council was planning to amend its registration rules so that doctors coming from English-speaking countries outside the European Union, such as Australia, would no longer have to sit clinical and English-language exams. He believes this could help to solve the problem.
The shortages have resulted in junior doctors who have very poor English being employed in Ireland. Prof Murphy says he is extremely concerned that, under current EU rules, doctors coming to Ireland from EU countries in which English is not the first language do not have to sit a language proficiency test.
This is making the Medical Council’s job of protecting patients more difficult. The council has to register these doctors but he says employers such as the HSE must satisfy themselves at interview about the fluency in English of the doctors.
He wouldn’t comment on the case highlighted recently, at Our Lady of Lourdes Hospital, Drogheda, of a junior doctor whose English was so poor he could not work on call.
Prof Murphy said, however, that he understood that from July 2011, the HSE would insist that all interns who hadn’t graduated from an Irish medical school sit an English-language test.
Furthermore, the medical regulatory authorities in 23 EU states last month signed a declaration, referred to as the Berlin Statement, calling on the European Commission to modify the directive that prevents countries assessing the language competency of doctors moving between states to find work. The commission’s response is awaited.