There is growing concern that some medics are not who they say they are. How can patients be protected from charlatans, asks Joe Humphreys
Have you ever asked if your GP is registered? No? You should do, says Stephen McMahon, chairman of the Irish Patients' Association. "Anyone could put a plaque up in their hall and call themselves a doctor. How do you know they are who they say they are?"
His comments come amid heightened concern this week about the existence of bogus doctors. Last month, his association wrote to Micheál Martin, the Minister for Health and Children, highlighting reports of a person in the eastern region posing as a GP. The move comes more than a year after Dr Maurice Guéret, a member of the Eastern Regional Health Authority, complained to the Medical Council and the Garda about the same individual, apparently with no result.
Whatever the outcome of the case, attention has been drawn to the policing of regulations - or the lack of it. The Medical Council, which registers practitioners, says it has no enforcement function. So too the Department of Health and Children. That leaves the Garda, which can act only on a specific allegation from a patient. In the case in question, gardaí say they have not received one.
Thus, says Dr Guéret, nothing happens. "The guards don't take action. The Department doesn't take action. And I don't think patients are being protected." Worse than that, he says, Ireland is in danger of becoming a sanctuary for rogue doctors who have been struck off the register in other countries or have no qualifications. "At least one or two cases crop up each year. I'm sure for those there are one or two we don't know of."
One recent case he cites is that of an African doctor who was allegedly performing "kitchen-table circumcisions", which in one instance almost caused a boy to bleed to death.
As to the number of such cases or complaints, nobody keeps a record. This alone, says McMahon, proves the system is failing.
Just how freely a bogus GP can operate is difficult to establish. The Medical Practitioners Act defines a registered practitioner and demands that he or she be accredited to the Medical Council. Someone who carries out actions reserved for such practitioners, such as issuing prescriptions or drawing blood, is prosecutable.
But similar functions, such as advising on over-the-counter drugs, prescribing unrestricted complementary medicine or commissioning blood tests, as a chiropractor or osteopath might do, are legal.
Anecdotal evidence suggests prescription fraud is particularly common. As well as bogus GPs, chemists have to deal with the threat of forged or doctored prescription slips.
"Stolen books are a constant hazard," says Janet Dillon of the Irish Pharmaceutical Union. "We tend to be warned about them, however, and as a result they are easier to pick up than, say, a bogus doctor."
Although chemists can look up patient numbers under the General Medical Services scheme on computer, they do not have access to the Medical Council's database. As a result, checks on suspicious prescriptions can be time-consuming and haphazard. "It tends to be more intuitive," says Dillon. "You would check the doses as a matter of course and would be extra-vigilant if they were for benzodiazepines, [such as Valium, Librium or Rohypnol], more so than if someone just came in looking for a cough mixture."
One practical solution, says McMahon, would be for the Medical Council or another agency to issue chequebook-style prescription pads to all GPs. Under such a plan, only official dockets, with printed doctor details and registration numbers, would be accepted by chemists. Such protections were introduced in the UK in April 1998, following a study showing a loss to the NHS of €150 million from theft and fraud in prescription drugs.
To doctors, the threat of bogus GPs raises broader questions about policing of the profession. Dr Cormac Macnamara, a former president of the IMO (Irish Medical Organisation), says "doctors are concerned about a number of activities going on outside the law. There's concern about a number of clinics, privately- and UK-owned, which are setting up and advertising, or offering services directly to the public, promoting a range of medical 'options' ".
These include cosmetic-surgery clinics, which have reportedly flown in consultants from the UK, and vaccine sales operations, which market single-component measles, mumps and rubella vaccines - vaccines that in some instances have attracted safety warnings from the Irish Medicines Board. Such operators are creating an "artificial market by hyping up angst and concern among the public about particular issues", says Dr Macnamara.
Like many, he sees it as a downside of expanding "patient choice" into areas such as alternative medicine. While you have to have an open mind, he says, "we would like to have the same standards of proof apply across the board. That's because we see the damage which happens when patients have their hopes built up only to find out the treatments they've been receiving are bogus."
Regulation of alternative and complementary medicine has been talked about for some time. Last November, a report commissioned by the Department recommended that selfregulation "should be developed rapidly . . . as a first step in the regulation process". Since then, a subcommittee comprising the chief executives of the health boards has been set up to examine the issue in greater detail.
As for the threat of bogus doctors, the Department says it will pass on any information to the Pharmaceutical Society of Ireland, the regulating body for chemists.This, however, does not satisfy Olivia Mitchell, the shadow minister for health and children, who tried without success to question the Health Minister about the matter in the Dáil.
"There seems to be nobody accountable for policing, despite all the regulations and rules which are there, and the only person who suffers in that situation is the patient," she says.
Apart from the Department, she would like to see action from the medical profession. "If this was happening to a point where it was depriving them of income, they would be dancing up and down about it. I wish they would be as vocal when patients are at risk."
One welcome initiative would be for the Medical Council to oblige GPs to display their registration numbers in their surgeries. Another would be for it to run an advertising campaign to encourage patients to seek them out, says Mitchell, who will try to raise the issue in the Dáil again next week.
In the absence of new controls, the burden will fall on patients to police the area. "You can't be too vigilant," says McMahon. "One bogus doctor could do 10,000 consultations in a year. Think of the damage that could cause."