Blaming consultants is not the way to address the problem of medical error, writes Finbarr Fitzpatrick.
Errors do occur in Irish - and all other - hospitals. In that Mary Raftery (Irish Times, January 12th) is correct. Where she is fundamentally wrong is to maintain that the medical profession in Ireland endeavours to hide its mistakes.
Moreover she largely ignores the issue that is so apparent to everyone working in Irish medicine: our hospitals are underfunded to the point that lives and patient welfare are seriously threatened.
Medicine is an inexact science and errors occur in the best hospitals and in the best health services throughout the developed world. We have new procedures which are risky but before we had them patients had almost 0 per cent chance of survival. Regrettably, errors will never be entirely eradicated. We work with risk-management and protocols to minimise the frequency of errors and, when they occur, we implement review protocols and systems in an effort to avoid a repeat.
Ms Raftery has produced no evidence to support her most offensive contention that the medical profession is secretive about its mistakes. In many areas of medicine there are internationally accepted levels of error which have been repeatedly highlighted in medical literature. These statistics are compiled by the medical profession, in Ireland and elsewhere, reviewing their work and being open and honest about mistakes, whether made by themselves or by other hospital staff.
In cytology, for example, there is a 10 per cent irreversible false negative rate. Errors arising from these false negatives may be minor or in some instances may have serious consequences for patients.
The general rate of error in pathology tests internationally is 2 per cent.
In medical genetics, which is a relatively new development, the success rate is 50 per cent internationally. Put another way, it has an error rate of 50 per cent. Undoubtedly the rate of success will increase into the future as medical information and technology improves.
In mammography the international error rate is 30 per cent. There are perfectly sound medical explanations for this level of error that arises from the rate at which tumours develop. An added factor is the relative limited capability of the technology used.
In anaesthesia it is estimated that one in every 200,000 anaesthetics will have an adverse outcome, even in healthy patients.
Various audits in radiology have indicated error rates of 3 per cent to 6 per cent in some procedures.
This is not like the manufacturing industry. We are striving to achieve what was not possible yesterday. It is not always possible today.
Any examination of the actual workings of our hospitals would have shown that it is the under-resourcing of our hospital services that is by far the greatest contributory factor to mistakes being made by doctors, nurses and other health care workers.
The tragedy is that as a society we know how to solve this and we don't do it. We need taxpayers' money, well directed into beds, equipment, more staff. Despite increased healthcare funding in recent years, the Irish healthcare system is ranked 28th by the World Health Organisation (WHO), behind every one of our current EU partners. Consultants and other hospital staff work in a "hand-to-mouth" healthcare system.
When stories break about a build-up of patients in A&E units, it must be remembered there is huge pressure on consultants to discharge patients prematurely to make way for other patients who have been on chairs and trolleys for days on end.
According to the OECD, Ireland has:
The second-lowest ratio of beds to population among member-states.
The shortest average length of inpatient stay.
The highest level of bed occupancy.
The lowest ratio of consultants to population.
Consultants frequently find themselves using equipment that is past its sell-by date. Of course, consultants know the risk to patients from such practices, but the alternative is the certainty of no treatment at all.
Equipment which has been decommissioned has not been replaced. I know of a consultant who worked for nine months from the boot of his car with no office or secretary. Today his clinic is run from an old clinic where five physicians are crammed into one room with (in his words) "inadequate space or facilities for proper, safe, correct assessment of patients".
The Irish Hospital Consultants Association had devoted a major part of its 2002 Annual Conference to clinical risk-management. The association is conscious of the need for constant quality improvement. Despite everybody's best efforts, the ultimate goal of an error-free service cannot be achieved. Not here. Not anywhere.
Our hospital service is emergency-driven. In excess of 70 per cent of admissions are emergency patients. Add to this the waiting times in A&E units to bed shortages and staff shortages and you have a recipe for error.
The WHO has always ranked this country as one as the safest countries for obstetric deliveries. Yet, according to the Medical Protection Society, Ireland has the highest level of malpractice litigation after the US and a consultant obstetrician can expect to be sued twice every three years in Ireland. Other consultants can expect to be sued once every seven years. The climate of litigation is such that the medical profession has to be constantly aware that any adverse outcome may result in litigation.
The vast majority of Irish hospital consultants would have spent all or the greater part of their training in the UK, North America or mainland Europe. They welcome continuing medical education, continuing professional development, peer review, audit and the general maintenance of best medical practice.
It is time to see that we have personnel throughout our medical service who are world class but who are starved of the beds and equipment they need for their patients.
Finbarr Fitzpatrick is Secretary General of the Irish Hospital Consultants Association.