In May, the Irish Medical Council announced a 13 per cent increase in annual registration fees for doctors to €605, at a time when the country is struggling to retain or attract doctors to work in the Irish health service.
I was on the receiving end of a fitness-to-practise inquiry in April 2015 that made me aware of the expense involved in the regulation meted out by the council. A complaint was made against me in July 2012. After a preliminary investigation lasting 2½ years, a decision was made in January 2015 to proceed to a formal inquiry. The council’s website states that investigation of complaints will take up to five months “or a little longer”. Two years is rather more than “a little longer”; it is also most unsatisfactory for the complainant and leaves a cloud hanging over the doctor for much too long.
Costs snowballed
The process then really hotted up and costs snowballed. In the three months leading up to the inquiry, I received a dozen letters, 25 emails and 10 phone calls from a firm of solicitors. A report from a second consultant neurosurgeon was sought. A barrister was hired to represent the council. Multiple witness statements were taken from about 10 doctors involved in the complainant’s care.
The irony is that I had retired nine months earlier; it was like being called to the headmaster’s office for talking in assembly months after leaving school. I had no wish to remain on the medical register and, in various communications to the council, I had pleaded guilty to the main substance of the complaint – I had failed to explain the possible complications of a surgical procedure for facial pain; and I did not follow the rules for obtaining informed consent. It was a procedure that I had performed 350 times with minimal morbidity. I performed poorly in this case and the patient deserved much better from me.
The inquiry, when it finally took place, was brief and fair.
The succession of phone calls, letters and emails over three months felt like a form of harassment which came to weigh heavily upon me. If the case had been much more serious or if I had been at great risk of suspension from the medical register I would not have been able to continue working during this period (I am now a half-time lecturer in surgery). I discovered that 28 doctors in the UK died by suicide over the eight years up to 2013 while under investigation by the general medical council (according to a report by an independent consultant, commissioned by the council). Faced with a legal barrage like the one above, I can understand why.
Morale damaged
After 35 years’ experience as a surgeon, I cannot see that costly regulation of this kind makes our health service more effective and less prone to mistakes. There is no evidence that the fitness-to-practise process in
Ireland
or the UK improves the quality of patient care. There is also no evidence of a decline in standards to justify the vastly increased activity and expense of the Medical Council’s investigations. The biggest mistake they ever made was to let lawyers become involved with their inquiries: this led to an exponential rise in costs. The increased regulation has undoubtedly had a damaging effect on professional motivation and morale. I am also pretty sure that the stress of the proceedings will make doctors far more likely to make mistakes or misjudgments in the care of their patients.
The regulation industry and the setting up of inquiries has been a growth industry in Ireland over the past two or three decades. Because bureaucracies and lawyers have a vested interest in perpetuating this work, there is a natural trend for such activities to snowball. But they are extremely costly and very unproductive; and one wonders how much more regulation and processing of complaints is sustainable without a healthcare system – and its practitioners – imploding.
Charlie Marks is a former neurosurgeon at Cork University Hospital