John Hillery, president of the Medical Council, responds to Maurice Neligan's columns on the Neary affair which have appeared in recent weeks.
It is unfortunate that the articles by Maurice Neligan over the past few weeks could be interpreted as a warning to patients to stay out of the regulatory process. This is not an option.
The way forward is for patients and doctors to work together. Our aims are indistinguishable. We must advocate for the rapid introduction of a multi-faceted approach to quality healthcare including proactive regulation that requires doctors to prove their competence on an ongoing basis rather than it being taken for granted for the rest of their careers.
The Lourdes Hospital Report holds lessons for all health professionals. It needs to be read and reflected on. It cannot be dismissed as the simple story of one man's aberrant behaviour, which is what Mr Neligan has suggested.
Those who think that is what it is about are missing the point. A question for the public and the profession is how such practice went on, seemingly unnoticed, for so long? People also ask, is this a unique set of happenings? People want to believe that it is and want to be assured that it is.
This is therefore a watershed in the evolution of the medical services in Ireland. Now all involved in those services must reflect and react. Our reactions must be such as will assure patients that no such practices are happening now and that no such situation can happen again.
Research suggests that doctors remain the most trusted of groups. My everyday interactions with patients support this. This is the privilege of being a doctor. Patients take for granted that we are what we claim to be. They trust us with their secrets, their fears and their lives. They trust our integrity.
Patients believe we are up to date. They trust us to have their best interests at heart. The philosopher and concentration camp survivor Elie Wiesel expressed the core sentiments of the patient-doctor relationship recently when he asked "am I naive in believing that medicine is still a noble profession upholding the highest ethical principles? For the ill, doctors stand for life and, for us all, hope."
Trust was earned through the actions of generations of selfless doctors. It is more than unfortunate therefore if the actions of a minority weaken or even destroy it. I believe that trust continues to be deserved by the majority of medical practitioners who cope in difficult conditions, give service, keep up to date and do not question their primary duty as being the welfare of patients. However, I cannot prove this.
In the past few weeks I have been challenged with the proposition that events in the Lourdes Hospital were representative rather than an aberration. It is no longer sufficient for me, or any doctor, to answer that everything is all right, trust us.
Internationally, accountability is accepted as part of professional life. Why should we be different? Speaking at a forum on medical professionalism recently the Director of Ministry for the Church of England said that "inappropriate privilege is when it is simply claimed a priority".
Trust is a key part of the therapeutic relationship. For any doctor who takes the time to read it, the contents of Judge Clark's report must be distressing. Trust has been weakened. We must revive it. That is why the implementation of proactive medical regulation which requires all doctors to manifest current competence is important. This can only be achieved as part of a properly resourced health standards system that is statutorily provided for. Doctors are only part of the answer. The system as a whole must change and be accountable. A system of clinical governance must evolve that will support competence assurance activities for doctors and other allied professionals and promote active and meaningful audit across the health service. Hospitals and other health service delivery settings must not be allowed to deliver services for which they are not accredited. This is dangerous for patients and stressful for staff.
Judge Clarke and the brave patients who told their stories have given us the foundation and the map to move forward.
There has been enough posturing on these matters over the years and it is time to move on.