News Analysis

Monday 1 September 2014

Eilis O'Hanlon: Caring profession that seems to care about itself first

Eilis O'Hanlon

Published 02/12/2012 | 05:00

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Visit the Irish Medical Times website and the first thing that appears is a box saying: "This site is aimed at healthcare professionals. Are you a healthcare professional?" Being the honest kind, and assuming on my visit that the question was merely there for research purposes to ascertain who was using the service, I clicked No.

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Another box then popped up, declaring: "This site contains information, news and advice for healthcare professionals. You have informed us that you are not a healthcare professional and therefore we are unable to provide you with access to this site."

Naturally, I just angrily deleted all my tracking cookies, returned to the Irish Medical Times website, and this time lied. Hey presto, I was allowed in.

Now you could see that as just one of those little technological irritations of modern life, like automated phone lines; on the other hand, you could see it as symptomatic of a certain attitude of mind in the medical profession. They might as well have asked: "Are you sure you're good enough to hang out in here with the likes of us? This is for people who are much cleverer, and certainly earn much more, than you. If you're not qualified to have your own parking space at the Blackrock Clinic, don't bother wasting our time by trying to crash this party. You'll just make yourself look silly."

Of course, it's not only doctors. All professions have this same kneejerk protective instinct. They all project an inner smugness at being the appointed guardians of some sacred mysteries known only to them. They love to shut the door behind them, nestling their specialisms like a miser with his gold. What makes it worse when doctors do it is that, while other professions might make mistakes, doctors bury theirs.

A much more serious example of that solipsistic medical mindset came last week at the Irish Medical Council, where one Dr John Stewart McKenna (28) was facing a fitness-to-practise inquiry for a series of incidents when he was working at St Michael's Hospital in Dun Laoghaire between January and April 2011.

The first involved the falsification of blood test results for a patient he was referring to the hospital's Warfarin clinic ("I didn't think it was a big deal," he told the inquiry). The second was a refusal to "rechart drugs" for a patient who was being readmitted, despite being told by the assistant director of nursing that nurses were unable to give the patient medication until he did so ("I thought the nurses were being awkward and difficult," was his excuse this time, though he did shortly afterwards relent). A third complaint related to when he was woken up by a nurse but refused to review the condition of a patient who had fallen out of bed. To this news, he allegedly said: "I don't care."

Most lay people would regard a doctor refusing to look after patients in need as an "I'm A Disgrace, Get Me Out Of Here" category of offence; but the Irish Medical Council decided otherwise. The fitness to practise inquiry made no findings of professional misconduct or poor professional performance against Dr McKenna. Instead he consented – consented, no less – to being censured while giving an undertaking not to do it again. Which is nice. In the meantime, he has switched to another hospital where he continues to work, no doubt diligently and professionally, having learnt his lesson.

And to be fair, he did have some excuses for his behaviour. As a junior doctor, he was regularly working between 40 and 70 hours a week, which is, as he himself pointed out, contrary to the European working time directive, which states that nobody should work more than 48 hours a week. When he said that he was "tired a lot" and that "it had a negative effect" on his "interpersonal skills", there's no reason to doubt that

he was telling the truth. He had excellent references from colleagues, too. But he did also admit that, at the time, he was getting up at 5am every morning to train for a so-called Iron Man triathlon, which suggests that some of his tiredness was self-inflicted. Patients should not be expected to suffer just so that a doctor can indulge his hobbies.

City traders who lose billions don't get a free pass on the grounds that they were tired at the time, after all. Johann Hari's career was destroyed simply for lifting a few quotes from other journalists' interviews. TDs who make mistakes can, likewise, be voted into unemployment at the next election, and if you don't like the way a chap runs his corner store then you can shop elsewhere. But it seems, bizarrely, that there's less accountability as the decisions a professional has to make grow in importance.

The Irish Medical Council's ruling scarcely counts as a slap on the wrist.

Sunday Independent

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