Scientific Session 3
IMO AGM Debate – 30th April 2011
Motion for Debate: This House believes that Over-regulation of medical practice will undermine the doctor-patient relationship
Proposer: Dr Anthony O’Connor, NCHD Member
Opposer: Dr Richard Brennan, GP and Former Chairman of the ICGP
Speaking at the first IMO AGM Debate were Dr Anthony O’Connor, NCHD Member and Dr Richard Brennan GP and Former Chairman of the ICGP.
Proposing the motion - This House believes that Over-regulation of medical practice will undermine the doctor-patient relationship – Dr O’Connor began by drawing attention to a number of articles that had appeared in the media in recent weeks. The first was a survey by the Medical Council which was published in the Irish Times where it emerged that doctors are the most trusted profession. The second article appeared in the medical media announcing that the incoming process of competence assurance was enforceable for the moment the Medical Council passed the rules and that their passage through the Oireachtas was a mere formality. The third was an article in the Daily Mail that referred to consultants as “muggers”. Dr O’Connor suggests that:
“Every move that has been made in this country relevant to the regulation of doctors in the last four years has been made to appease the lunatic fringe of anti-medicalism”.
We have a bizarre situation where fitness to practice hearings are conducted in public with the guilt of the doctor is presumed until proven otherwise and whatever the verdict his or her reputation is left in tatters. Defensive medicine is a real and increasing cost. Dr O’Connor questioned why we are pandering to the prejudices of hysterical, uniformed anti-medical commentators, forcing doctors to attend “independent” CME activities sponsored by big pharma companies, when 88% of people trust their doctor and don’t care if he or she has not carried out an audit in the last five years?
In a final word on regulation and regulators, Dr O’Connor argued that regulations have been in place for years to protect doctors and patients regarding the hours worked by NCHDs which have been uniformly and brazenly ignored. What is needed is better regulation, better enforced, but not over regulation.
Dr Richard Brennan, opposing the motion, argued that he does not believe in the concept of over-regulation - regulation is either appropriate or inadequate for purpose. Regulation exists to protect both patients and doctors. It is about maintaining standards accountability and trust. Most doctors subscribe to the ideals of professionalism and excellence therefore do we not all support the concept of patient safety and quality in healthcare?
“It is not about over regulation, it is new regulation which incorporates many of the best values and aspirations of medical professionalism together with the voice of the patient”
If the patient is to be put first, then Dr Brennan suggests that it is time to rebalance the doctor-patient relationship and that we should perhaps now refer to the patient-doctor relationship which is a relationship of partnership, based on trust, mutual respect, individual responsibility and appropriate accountability. It is a relationship governed by values, behaviours, cultures and quality of communication.
Deficits in our values systems and behaviours undermine trust. Basic behaviours of courtesy, kindness, understanding, honesty and humility are ore often absent and perception and reality about communication between doctors and patients can significantly differ.
Contrary to the motion proposed, Dr Brennan believes that the balance and thrust of regulation to date is appropriate and not over-punitive, it rebalances the patient-doctor relationship in a way that reflects modern societal values and it provides a safety net and accountability for patients. Medical professionalism is about doing the right thing and our best for patients. Regulation is the flip side of the coin and is complimentary rather than conflicting.
Following further questions and answers, IMO doctors in attendance voted marginally in favour of the motion.