Medical Council Warnings

The Irish Medical Times, April 14 carries and interesting front page article which draws attention to a situation which could have very serious implications for hospital doctors; which the piece deals with, but also by extension for general practitioners.  This piece by Greg Baxter tells us that The Medical Council will hold consultants accountable for the safety of discharged patients, even if hospital management have put pressure on them to free up capacity.  The Council’s vice -president Dr. Colm Quigley is quoted as saying, “If a doctor discharges ill patients, then it is on the doctor’s head, not on the administrator’s.  The argument that a doctor felt forced by management to discharge ill patients will not work in a Fitness to Practice hearing.”  The president of the Medical Council Dr. John Hilley is quoted in the piece as saying that doctors must be able to stand over their decisions, “Being told by an administrator to discharge a patient does not constitute a clinical decision. “

Clearly hospital doctors of all ranks must look very seriously at these statements coming as they do from the top echelons of their ruling body, the Medical Council, for failure to heed these warnings not alone will expose them to censure or worse by the Medical Council but almost certainly it will also leave them wide open to litigation, a possibility which has already become almost inevitable on the heel of the words of warning issued by the council. 

Hospital doctors expose themselves to censure and litigation by being brow beaten into making over-hasty discharges, or indeed failure to admit in the first place by overcrowded hospitals and overzealous administrators.  General Practitioners also expose themselves however to such dangers by taking too much cognisance of warnings of bed shortages, casualties over flowing with full trolleys and wards closed due to seasonal vomiting virus, none of which will act as a defence I should think in the case of a GP either being sued, being brought before the medical Council or most likely both, in the case of a patient who came to grief or perceived grief because he or she was not referred to hospital.  General practitioners when wrestling with the decision of whether a patient should or should be referred to A/E should as far as possible exclude the issue of overcrowding in A/E from their calculations. Failure to do so, could come at a very great cost.  The situation with regard to referring patients for OPD appointments also deserves consideration.  If the Medical Council feels, as it does, that “If a doctor discharges ill patients, then it is on the doctor’s head, not an administrator’s,” then what is the Medical Council’s opinion with regard to patients having being referred for OPD appointments by their family doctor, being offered appointments to see the selected consultant at very often ridiculous dates way into the distant future.   Every GP is familiar with the situation whereby having sent off a referral letter for a patient the patient returns sometime later with the appointment card and with a rather bemused look hands it to the GP saying, “remember that letter you sent off for me to be seen in the hospital, well this came for me today.”        

“Ah! Yes,’ you say perusing same, “Sept. 4th. Three months away that’s not too bad”

“Eh! Doctor would you mind checking the date again.”

“Yes I see, Sept. 4th. 07.” And when we consider here that most public OPD appointments for some time now have only been issued upon receipt of a GP’S referral letter; which presumably the consultant is supposed to read and consider prior to issuing an appointment date, what I wonder is the Medical Council’s opinion of consultants sanctioning appointments for newly referred patients, 15 months down the line.  Or indeed what is its stance on the same appointments being scheduled 12, 6, or even three months later. 

It is my view that consultants standing over appointments rostered at some point in the distance, way over the horizon, could well be placing themselves at risk if not at the hands of the Medical Council, well certainly at the hands of litigants.  And as in the case of the early discharges, the administrators, departmental mandarins and politicians ultimately responsible for the mess will always manage to remain unaccountable.  And of course very  often GPS when needing  a  further opinion and  knowing that an OPD appointment will be given simply too far into the future, resort to the only option open to us and that is referral to A/E.  Not by any manner of means the ideal option, but alas the only one.

When is an OPD appointment and OPD appointment? I am speaking here of referrals in the first instance only.  It is my view that to be of any real benefit for the most part GP referrals ought to be seen within a couple of weeks, a month tops. Clearly some patients must been seen earlier still. 

Giving OPD appointments three, six, twelve months down the road, is not in my view offering the patient an OPD appointment for the treatment of the ailment for which they were referred. By then the ailment will either of have been cured, resolved itself, advanced beyond help or killed the patient