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'No profession has a public trial for making a mistake at work, other than doctors'

Lorraine Courtney writes that naming doctors in fitness to practice inquiries should be scrapped.

WE’RE BOMBARDED DAILY with healthcare stories that are invariably about hospital trolleys and the doctors’ misdemeanours. The system is blamed, repeatedly and ardently.

Yet it is this very healthcare system that routinely ranks at the top of global ratings in practically any measure of health and welfare you can think of: infant mortality, childhood immunisation, infection control, adult life expectancy, cancer survival… the list goes on. However, in one report this week, Ireland fell at a number of hurdles.

So what’s going wrong? The doctor-patient relationship can be complicated and one of mutual respect and cooperation, looks further away than ever. Throw in a media that loves a “doctor behaving badly” story, with access all areas to doctor trials and you’ll see why last year’s report from the Medical Council attributed the “rising tide” of complaints to a “sustained diet of negative media coverage of doctors.”

The report looks at some 2,000 complaints handled over a 5-year period. It found that the numbers of doctors who were complained against rose from 335 in 2008 to 488 in 2012; this represents a 46% increase in number of complaints against doctors in the review period. It means that for doctors, the likelihood of being complained jumped from 1.9% to 2.7%.

Rise in complaints 

So what changed? The massive rise in complaints certainly reflects an increased readiness to complain across our society, rather than a decline in medical care or communication. We have increasingly high expectations. We want more from our health service. There’s a growing culture of complaint, and we’re encouraged all around us to complain.

But something else changed utterly too. The Medical Practitioners Act, 2007 brought about a major change to the way the profession is regulated. The 2007 Act requires professional misconduct enquires to be heard in public, unless at the request of either the medical practitioner or the patient, the Fitness To Practice Committee decides otherwise in the “interests of justice.”

So, we began seeing doctors have trials by media, dodging cameras on the 9 o’clock news and we were inspired to start making ever more complaints. What patients are objecting to is a long and sorry list of wrongdoings – some of them trivial, some tragic, lots, it has to be said, nonsense. Nonsense because of 1,961 complaints investigated by the PPC, 221 (that’s just 11%) were actually taken forward for inquiry.

Much is rightly said about doctors who harm their patients, but when it comes to discussing the ways in which patients can damage their doctors, there is silence. No system should rest on its laurels which is why feedback, constructive criticism, and when needed, the force of the law, are needed to make us aim higher.

Keeping doctors on their toes

The various complaints that filter in keep everybody on their toes. But with our crazily high levels of complaining, instead of more accountability, what society ends up getting is a more defensive, but ultimately more harmful, style of medicine – at an increased cost.

Minister Varadkar says he has spoken to a number of doctors about their feelings regarding the Medical Council. Some of the doctors had complaints “made about them in the past and felt wounded by it all, even when it did not go beyond the preliminary stages.”

There’s talk about no longer naming doctors in fitness to practice enquiries and this could be a start (and it does need to happen), especially since an alarming British study revealed the poisonous effect of complaints procedures on the mental health of doctors. It included alarmingly high number of suicides.

The study of 8,000 doctors also found that a sixth reported severe or moderate depression following a complaint, and many others reported anxiety and even suicide ideation.

Depression among doctors 

Just under 17% of those with a recent complaint were moderately to severely depressed. They were twice as likely as those who had no personal experience of a complaint to harbour thoughts of self-harm or suicide.

A similar proportion (15%) of those in the recent/ongoing complaints category were also twice as likely to have clinically significant levels of anxiety.

The Medical Council has a duty to protect patients, but it equally needs to protect its doctors.

It isn’t doing that now. No other profession has this kind of public trial for making a mistake at work. No wonder then that morale suffers and many doctors openly advise their children to pursue a career other than medicine.

Add to this the depressingly familiar statistics about the high rates of depression and stress in doctors, the financial struggles of those trying to maintain their practices and you might wonder why anyone chooses to stay in a profession that grows more imperfect by the day.

Lorraine Courtney is a freelance journalist. Follow her on Twitter @lorrainecath.   

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