SECOND OPINION: In a recent article on regulation of the medical profession, Dr Muiris Houston argued that over-regulation of doctors can inhibit them from making the kind of clinical judgments which may be in the best interests of patients, writes Sean Byrne.
Dr Houston's arguments are valid but he must be aware that in Ireland self-regulation of doctors means very little regulation with the majority of complaints to the Medical Council not even being investigated.
I know from personal experience that failing to attend a gravely ill patient for 48 hours after being called; failing to diagnose simple illnesses; giving inappropriate medication; and failing to keep records did not even merit investigation by the Medical Council.
The medical profession in Ireland often reacts defensively to incompetence, addiction or carelessness by colleagues. Even when doctors are investigated and evidence of dangerous practices are uncovered, they are often allowed to continue practising, with some condition attached. Britain's most prolific mass murderer, Dr Harold Shipman, is a hideous example of the failure of self-regulation by the medical profession. It was discovered that when he was a GP in Yorkshire the death rate of his patients was very high yet he was allowed to continue practising. He was in fact in jail, charged with dozens of murders, before the Medical Council got around to striking him off its register.
The failure rates of paediatric heart surgeons in Bristol Royal Infirmary were well known to their colleagues but they took no action to prevent them from continuing to endanger lives. When anaesthetist Stephen Bolsin blew the whistle on his incompetent colleagues, vigorous attempts were made to silence him.
In Ireland there are many incompetent doctors and doctors addicted to alcohol or other drugs whose incompetence or addictions are well known to colleagues but those colleagues never inform the Medical Council that their fellow doctors are endangering patients.
In the case of Dr Neary, the Drogheda obstetrician who performed so many unnecessary hysterectomies, it was nurses who, to their immense credit, eventually succeeded in having his activities scrutinised.
A review of Neary's hysterectomy rate by two Irish obstetricians found nothing untoward in his practices. In most of the medical negligence cases in Ireland, substantial compensation has been paid in settlements, but always without doctors accepting liability. And the doctors involved continue to practise medicine.
Medicine, like a number of other professions has, since its inception, jealously guarded its privilege of self-regulation. The concept of self-regulation was originally based on the alleged moral superiority of the professions.
Self-regulation was supposed to be a means of defending "professional standards". In practice self-regulation in medicine, as in all the professions, has always been an instrument to protect the self-interest of members, to restrict recruitment and to shield the incompetent and unscrupulous from public scrutiny.
The activities of doctors such as the Bristol heart surgeons and the horror of Shipman's long career of medical murder have increased pressure on the UK government to end self-regulation of the medical profession.
The British National Health Service now has the power to sack incompetent doctors and has introduced extensive systems for monitoring the performance of doctors. The present chairman of the Medical Council, Dr John Hillery, when asked about the case of Dr Neary, expressed revulsion at his actions but stoutly defended the self-regulation which totally failed to protect Dr Neary's patients.
The ineffectiveness of self-regulation is shown by the fact that in the period 1999 to 2004 the Irish Medical Council received an average of 235 complaints a year. More than 90 per cent of these were dismissed without a hearing. Of the 40 cases considered in 2002 (which included a backlog) the council decided that only 14 warranted further consideration.
In the period 1999 to 2004, the council received 117 complaints about doctors' failure to communicate and rudeness but only one case was investigated. Interestingly, while most complaints by patients about treatment are not even investigated, all complaints about advertising are investigated with alacrity.
Ireland has one of the highest rates of litigation against doctors in Europe which has caused a huge increase in insurance cost for doctors. Doctors' organisations try to portray Irish patients as particularly litigious but studies have shown that in fact doctors are sued in only about a third of cases where there are grounds for suspecting malpractice. The real reason is that self-regulation is dealing ineffectively with incompetent doctors
The Irish Medical Council has fewer lay representatives, investigates fewer complaints by patients and disciplines or strikes off proportionately fewer doctors than its UK counterpart. New legislation governing the regulation of the medical profession in Ireland is to be published shortly. It may remedy some of the deficiencies in the current system but if it preserves the principle of self-regulation, it will do little to reduce the threat to patients from incompetent doctors.
Sean Byrne is a lecturer in economics at Dublin Institute of Technology and has lectured in health economics.