A CONSULTANT dermatologist has difficulties visiting psychiatric wards because he cannot distinguish between the nurses and the patients.
And many of his medical colleagues have left wards in exasperation after being unable to find out who's in charge.
Dr John A Cotterill made the remarks as he gave evidence as an expert witness in a Medical Council fitness-to-practise inquiry.
The inquiry is hearing more than 100 separate allegations of poor professional performance and professional misconduct against Dr Adam Jacobus Smith, relating to 12 patients who attended his treatment rooms in the Whitfield Clinic, Waterford, from 2006 to 2009.
Dr Cotterill, who retired from his medical practice in the UK in 2002, has been called as an expert witness by Dr Smith's legal team, which is contesting the allegations against its client.
Under cross-examination from barrister JP McDowell, representing the CEO of the Medical Council, Dr Cotterill said he was often reluctant to make follow-up visits to patients in psychiatric wards because it is difficult to see who is and who is not a patient.
"When I have walked into a psychiatric ward in England you are met by five or six patients and you don't know which is the patient and which is the nurse."
After being asked by Mr McDowell if he was serious, Dr Cotterill replied that they were "all dressed in the same attire".
Later Dr Cotterill clarified to the inquiry that his comments were directed towards English psychiatric facilities and did not refer to any Irish institution.
"Some of my colleagues have walked out of these facilities because they are so frustrated," he remarked.
Dr Cotterill was giving evidence in respect of Patient I, a 78-year-old female resident of a psychiatric hospital in Waterford who was diagnosed with an auto-immune condition which causes the skin to blister. Dr Smith prescribed the woman with a steroid, prednisolone.
Among the allegations brought before the inquiry are that Dr Smith failed to take a skin biopsy of the patient, failed to arrange adequate follow-up treatment and failed to arrange for bloods to be monitored.
The case, which has so far been heard over 16 separate days since April 2012, has yet to hear evidence from Dr Smith.