Medical Council guidelines not centred on patients – Scally report

The Medical Council’s guide for doctors on ethics and professional conduct is not in keeping with a modern, patient-centred approach, Dr Gabriel Scally’s review states.

He says the Department of Health should hold talks with the council, the regulatory body for doctors, about strengthening the guide so that it is placed beyond doubt that its members must promote and practice open disclosure.

The council has a statutory role in protecting the public by promoting the highest professional standards amongst doctors.

The Scally report notes that the council’s ethics and professional conduct guide states that open disclosure is “supported within a culture of candour”.

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“You have a duty to promote and support this culture and to support colleagues whose actions are investigated following an adverse event,” the guide states. “If you are responsible for conducting such investigations, you should make sure they are carried out quickly, recognising that this is a stressful time for all concerned.”

It also says that “patients and their families, where appropriate, are entitled to honest, open and prompt communication about adverse events that may have caused them harm”.

“When discussing events with patients and their families, you should: acknowledge that the event happened; explain how it happened; apologise, if appropriate; and assure patients and their families that the cause of the event will be investigated and efforts made to reduce the chance of it happening again.”

Difficulty

However, the Scally report maintains that the difficulty with the guide was, firstly, that the interests of patients and families were not at the centre of its approach to open disclosure.

“It is unfortunate that the initial section appears to be about medical colleagues. Secondly, it is not definitive. The insertion of the undefined phrase ‘where appropriate’ creates uncertainty and can be interpreted in a range of ways. Thirdly, the use of the word ‘should’ can be taken to mean that it is something that is recommended, but remains optional,” Dr Scally says.

"The foreword to the guide stresses that it is not a legal code but rather a set of principles that all doctors are expected to 'follow and adhere to'. It is surely impossible to continue to accept a situation where the principles of open disclosure are not a fundamental and essential part of the professional conduct expected of all registered medical practitioners in Ireland. "

The Medical Council said it would it carefully consider the Scally report.

“The guide to professional conduct and ethics for registered medical practitioners is reviewed periodically and the recommendation from Dr Scally will be actively considered by the Medical Council,” it said.

Effective

The Irish Medical Organisation (IMO) said it was committed to supporting measures that would lead to an effective and safe cervical screening programme, and all other screening programmes, "recognising both the importance and limitations of screening".

The president of the Royal College of Physicians of Ireland, Prof Mary Horgan, said: "We will also contribute to initiatives to introduce a greater duty of candour and welcome Dr Scally's recommendation for public health expertise within the screening programmes."

The chair of the Institute of Obstetricians and Gynaecologists, Dr Peter Boylan, said it was often the way adverse outcomes were dealt with that could lead to anger and difficulties.

“These issues can be dealt with well at the beginning with open disclosure, but it needs to be legislated for.”