Monday 21 August 2017

Watchdog calls for an overhaul of medical complaints process

Patient expectations rise as more doctors suffer burnout, writes Eilish O'Regan

Chief executive of the Medical Council Bill Prasifka: ‘If doctors are not well looked after, it has
a knock-on effect for patients.’ Photo: Doug O’Connor
Chief executive of the Medical Council Bill Prasifka: ‘If doctors are not well looked after, it has a knock-on effect for patients.’ Photo: Doug O’Connor
Eilish O'Regan

Eilish O'Regan

Patients who make a complaint about a doctor to their regulatory body, the Medical Council, can wait up to six months before finding out if an inquiry will be held into the allegation.

However, this process could be speeded up in several cases if the current "conveyor belt system" for dealing with complaints was overhauled, said Medical Council chief executive Bill Prasifka.

He wants to see a loosening of constraints to allow the council more flexibility outside what he calls the current straitjacket which must involve an assessment of complaints by a preliminary proceedings committee which then recommends what further action should follow.

The time-lag of three to six months could be cut if the council was allowed to demand a written undertaking from a doctor early on, a form of pledge which would satisfy the concerns of many patients, he said.

"Currently a complaint goes to a preliminary proceedings committee and it is limited in what it can do with it," said Mr Prasifka.

"We would like the ability to be able to resolve complaints as quickly as possible in a manner that is satisfactory for the complainant and also protecting the public interest."

Serious cases would still go to full inquiry.

The council received more than 400 complaints about doctors last year and the trend is a small but steady increase in grievances.

"There are 20,000 doctors on the register. The number of complaints is not large but there is no sign of a fall," he said.

"We know that one of the things the patient wants more than anything else is to be able to sit down with their doctor and have them explain what happened, what went wrong and how can they ensure it will not happen again."

More should be handled early on by the treating hospital. Just 10-15pc of complaints are deemed serious enough for a full inquiry, a source of frustration to patients.

Compared to the past, however, and the secrecy which shrouded its proceedings, the work of the council, which has a lay majority, is much more transparent and around six in 10 inquiries are now held in public.

"There are always lay people on the panel who hear cases," Mr Prasifka said. "On a year-by-year basis the number and length of time inquiries are taking is increasing. The practice of medicine may be becoming more complex."

Patients now have a greater expectation of doctors.

Recurring themes in patient complaints over the years include failure to diagnose and treat a patient, problems with communication such as lack of appropriate information, and a perceived lack of respect.

The council vets all doctors' credentials before accepting them on the register. Free movement means EU-trained doctors are not subject to the same clinical and English language tests as those from outside the EU. However, since March last year the HSE has made an English language exam a mandatory part of its pre-employment checks.

High-profile cases of hospital doctors not being able to tell an elbow from an ankle have shocked the public in recent years. Mr Prasifka insists its screening procedures are "robust". The question is how many young doctors are plunged into high-pressure situations in hospitals, without the right mentoring or back-up.

Mr Prasifka pointed to growing concern that employers and training bodies have to do more to tackle job-related pressures.

Many medics, across all ages and specialities, will soldier to work today suffering from high levels of burnout, stress and depression.

The hidden mental strain suffered by members of the profession is bad for doctors and patients, he warned.

The ill-effects of working in a culture of blame, high workload and staff shortages are now coming through loudly in a range of surveys.

"There is no time for complacency. If doctors are not being well looked after it has a knock-on effect for patients," he said.

A council survey found a junior doctor in Ireland is four times more likely to be bullied than a counterpart in the UK, he added.

A recent study showed one in three doctors has suffered burnout and one in 10 had severe levels of depression, anxiety and stress.

He said the council is also stepping up efforts to ensure that all doctors on the register are maintaining their competence and keeping up to date with training and medical advances.

A percentage of doctors is ignoring this and it may have implications for patient safety.

Irish Independent

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