THERE IS widespread disquiet among general practitioners and other doctors following reports that a redrafting of the Medical Council's ethical guide could allow patients self-refer to consultants.
As reported in The Irish Timeslast week, the ethics committee of the outgoing Medical Council has recommended a softening of the existing guideline that advises consultants "should not normally accept a patient without referral from a general practitioner".
However, a proposed new wording of section D of the council's ethical guide, adopted by the ethics committee on March 26th, 2008, and seen by The Irish Times, states: "Ordinarily, consultants will see a patient following referral from the patient's general practitioner or other treating doctor. Where a consultant sees a patient without such referral, the consultant should inform. . . the patient's GP of the consultant's findings and treatment. Such provision of information should only take place with the patient's consent."
Sources have confirmed this new guideline was considered by the outgoing Medical Council at a meeting last Wednesday and was referred unchanged to the incoming council.
Although a final decision lies with the new council, which will have a lay majority for the first time, many doctors have reacted with concern at a move that effectively threatens the traditional gatekeeper role played by family doctors in the health system here.
Although sources maintain the Medical Council did not set out to encourage self-referral by patients, they accept the wording of the amendment could allow this to happen.
Dr Colm Quigley, outgoing president of the Medical Council, described the revision of the ethical guide as "work in progress". "Now that this interpretation [ of the referral guidelines] is out there, I hope the wording will be adjusted [ by the incoming council] to avoid misinterpretation," he said yesterday.
Dr Mark Walsh, chairman of the Irish College of General Practitioners, said he was concerned at the proposed change. "Even though on the surface it may give the appearance of patient autonomy, overall it is not in the patient's best interest," he added.
"Consultants may not be aware of the full story or of the person's past medical history."
Dr Deirdre Madden, chairwoman of the ethics committee, has been appointed to the Medical Council by Minister for Health Mary Harney and is expected to play a central role in the ongoing review of ethics guidelines.