Sir, - Prof Fahy of the Department of Psychiatry, NUI Galway (February 15th), states his views on the difficulties faced by the Medical Council in implementing its recent published proposals for regular accreditation of doctors on a new specialist register intended to guarantee the continuing competence of individual doctors and to assist sick doctors. He is concerned about recent suggestions that the royal colleges may set up their own bodies to which members and fellows report colleagues about whom they are privately currently worried, and by so doing "nip problems in the bud".
He is right to criticise the Department of Health and its political leaders for their pusillanimity over many years in updating the 1978 Medical Practitioners Act.
As I understand it (and I am currently seeking election to the incoming medical council in April) the royal colleges will appoint at least five members to the Medical Council and each constituent college of the National University of Ireland - including Galway - will also appoint one. The collegiate input to a total council of 26 members is therefore considerable. A psychiatrist representing that discipline has already been elected, unopposed. Ten members are elected from the medical practitioners' list of approximately 10,000.
The ethical issues, largely those of termination of life (in the womb to old age), are tightly covered by the recent pronouncements and guidelines of the retiring council, to the satisfaction, I suspect, of the vast majority of the profession.
There are foreseeable dilemmas that may ensue if the council might act to stricture a registrant for acts that are constitutionally legal. There are issues here that must be resolved with the executive over the five-year term of the incoming council.
In my view council membership should be broadened to include more lay people. Sick or incompetent doctors must be assisted without the ultimate, current, censure of public debarment.
The recent unresolved lengthy manoeuvrings by "litigants" for a public hearing (with the inevitable challenges) have been unhelpful (witnesses may not come forward) and are hugely expensive. These costs are borne by the profession and its insurers (legal representation at closed hearings is available and advised).
The Medical Council can regularise its own affairs to protect the public interest but it needs a new constitution of an enabling nature to modernise, accredit, reaccredit, adjudge and advise its registrants and continue to serve the public interest as it is bound to do.
There are no "cosy clubs", as Prof Fahy suggested the public might infer. The royal colleges, perhaps in their frustration with the current Act, even represented within it, are, I believe, attempting to serve the professional and public interest, fearing that there will not be a "new Act".
This area of public interest lies squarely with the Minister for Health and Children, whoever he or she will be. - Yours, etc.,
Dr G. J. Burke, FRCPI, FRCP Ed., Consultant physician/gastroenterologist, Mid Western Health Board, Limerick.