May 07 Edition.indd

Medical Council

NewsletterVolume 6, May 2007

The Medical Council regulates the Medical Profession in Ireland

Lynn House, Portobello Court, Lower Rathmines Road, Dublin 6, Ireland. Tel: +353 1 498 3100 Fax: +353 1 498 3102 www.medicalcouncil.ie

Is self-regulation the hallmark of a profession? Perhaps the concept that self-regulation is a core aspect of what we doctors understand as defining a profession is now outdated? The new Medical Practitioners Act sets out a new type of regulation for doctors in Ireland. Included in this is a new type of regulatory body. If we define ourselves as a profession by the presence of a majority of doctors on our regulatory body the future is uncertain. I do not believe that it should be or that our meaning as a profession is dependent on the balance of membership on the regulatory body.

The enactment of the new Medical Practitioners Act means that this is almost certainly my last Newsletter as President of the Medical Council. The last two years have presented many challenges for the Medical Profession in Ireland and for the Council. The actions of a minority of doctors have caused the public, at least as portrayed by the media, to question the validity of self-regulation in the modern world. I will always remember this time as President of the Medical Council as being often demanding but always a privilege. We doctors believe that the majority of our profession work competently and strive to maintain competence. I have given time to medical regulation because I think that it is a vital part of what we are as doctors. The World Medical Association has stated as a principle that self-regulation is a duty of the medical profession (1). Regulation starts with the individual practitioner, continues through local professional groups and national bodies and is publicly manifest in our qualifications and our ongoing registration. The registration must be a guarantee of an individual’s competence.

Research shows that members of the public believe that registration is backed by ongoing robust reviews of individual competence (2). The Medical Council, with the support of the profession, has developed such procedures for Irish practice. The campaign for new regulatory legislation that supports good practice and involves non-medical people in a greater and meaningful way has led to the new Act that will deliver such medical regulation in Ireland. The Act also increases professional involvement in medical education and guarantees autonomy for the Council and the Profession as regards the core principle of the ethics of the profession as a whole and of individual doctors. The Act needs to be read thoroughly in order to elicit its core benefits, as some of the public commentary has been disingenuous and misleading.

It is disappointing that the Act does not guarantee ongoing Medical leadership of the regulatory process. If certain appointments to the new Council go to non-medical people then there will be a non-medical majority on the Medical Council for the first time. Indeed this seems to be a first internationally. This will be a new form of regulation for the medical profession. It will not be self-regulation as we understand it but does that mean we are no longer professionals? The public representatives will decide the format of the regulatory process. However the challenge for individual doctors and for the profession as a whole in Ireland is to accept this new format and to move on and demonstrate in our daily working lives what we mean by our profession. Recent years have seen a welcome interest in the idea of medical professionalism in the academic press, in the deliberations

of professional bodies and in the activities of some representative bodies (3,4,5). Raymond Tallis, reporting on the work of the Royal College of Physicians Working Group on Professionalism, wrote that at the culmination of their consultations “an easy definition” eluded them but that “central to the new professionalism was the notion of a partnership between patient and doctor based on mutual respect, individual responsibility and appropriate accountability”(6). This relationship entails duties on both sides. The final document gives the following definition: medical professionalism signifies a set of values, behaviours and relationships that underpins the trust the public has in doctors (5). It follows therefore that the key function of regulation is that it works to promote professionalism. Wynia et al (7) put forward the three core elements of professionalism. Their belief is that professionalism is “more than merely an activity that straddles market competition and government regulation.” “Professionalism is a structurally stabilising, morally protective force in society.” The three core elements they describe are: “Devotion to medical service; Public profession of values; and Negotiation regarding professional values and other social values”. The key to being a profession is the liberty and determination to carry out these tasks.

In an inspiring piece in the BMJ recently (8) Loxterkamp recounts the lessons of a lifetime experience in medicine. Two issues stand out. These are the importance of being part of a community, both professional and societal, and the need to adapt to change. The Medical Practitioners Bill seems to have the support of the majority in the Oireachtas. The Medical Profession in Ireland has made the case for continued self-regulation of the traditional type. It appears that this will not continue. The challenge now for the profession and for us as individual members is how we will respond. Historically benefits have come from the ability of the profession to adapt to change and, indeed, to lead it. The coming months will show our ability to continue to do so in a way that underpins our professionalism rather than the stereotyped view of anachronistic reactionaries some people would like to portray.

1) World Medical Association 39th World Medical Assembly, Madrid, 1987 & revised at 170th Session 2005.

2) www.mori.com/pdf/2005/pdf/doh.pdf

3) Medical Professionalism in the new millennium: a physician charter. Ann Intern Med. 2002; 136: 243 - 246.

4) Medical Professionalism in the new millennium: a physician charter. Lancet. 2002; 359: 520 - 522.

5) The Royal College of Physicians. Doctors in Society: Medical professionalism in a changing world. Report of a Working Party of the Royal College of Physicians of London. London: RCP, 2005.

6) Tallis R. (2006) Doctors in Society: medical professionalism in a changing world. Clinical Medicine 6 (1): 7 - 12.

7) Wyania M. K., Latham S. R., Kao A. C., Berg J. W. and Emanuel L. L. (1999) Medical Professionalism in Society. NEJM 341: 1612 - 1616.

8) Loxterkamp D. (2006) Living conditions. BMJ 333: 1323 - 1325.

President’s Message

Dr. John A. Hillery

Medical Council Newsletter Volume 6 May 2007

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Registrar’s Message

The subject of statutory regulation of the medical profession has rarely been more commented on, in print or speech. That is a good and positive development. It is important that professionals, and the public they serve, are given the opportunity to understand the benefits, and occasional pitfalls, that are associated with statutory regulation.

What may not be widely appreciated is that statutory regulation has a long and frequently controversial history. In 1512 the English Parliament passed an Act which, though dealing chiefly with London, restricted the practice of medicine within a seven-mile radius of London to graduates of either Oxford or Cambridge, unless they had been licensed by the Bishop of London on the recommendation of four physicians. Six years later, in 1518, the College of Physicians was set up as the formal regulatory body and in 1523 the existence and authority of the College extended over the whole of the ‘Kingdom’. The origins of the Royal College of Surgeons in England lie in the Company of Barber-Surgeons formed by Henry VIII in 1540. Although medicine at that time involved many types of practitioners, not all practised in a scientific manner. A publication entitled ‘Errors of recent doctors’, published by Leonhart Fuchs in 1530, dealt with some of the problems of medieval medicine.

One aspect of regulation legislation that has not changed a great deal is that the underlying intention continues to be the protection of the public through the setting of standards in education, training and practice.

The aspect that has changed most is that regulation of the medical professions is now an international activity involving seventy-eight organisations in 32 countries1. These seventy-eight organisations are responsible for the many different aspects of regulation in their respective countries but no other national organisation has retained the compete set of responsibilities retained by the Medical Council in Ireland.

The new Medical Practitioners Act not only preserves the range of regulatory functions of the Medical Council but extends these functions to include measures to ensure the maintenance of professional competence. The new Act also enables the Council to involve many more members of the profession in the carrying out of its functions; functions which, under the current Act, are carried out by members of the Council. While there has been much comment on the membership of the Council under the new Bill which allows for, but does not guarantee a non-medical majority, the new measures provide the medical profession with an enhanced involvement in the regulation of the profession.

After the new Council has been established, we will be seeking the involvement of registered medical practitioners in the accreditation of medical schools, postgraduate training bodies, assessment of complaints, establishment of standards of competence, supporting doctors with health difficulties affecting their ability to practice and other related activities envisaged in the new legislation. The new Act also envisages arrangements whereby fees can be paid to those providing their services to a future Council. While this will be expensive it does give due recognition to the fact that a statutory body should not expect to have access to professional expertise at no cost and this is a welcome development.

The Medical Practitioners Act provides an opportunity for the medical profession to set standards relating to a wider range of health related issues than before.

1 Based on the latest information from the International Association of Medical Regulatory Authorities (IAMRA).

John Lamont

Election of doctors to the new Medical Council under the Medical Practitioners Act 2007

At the time of going to press the Medical Practitioners Act 2007 was signed into law by the President. The date on which the Minister will sign the order to activate the provisions of the new Act (the commencement date) has yet to be determined. The new Act provides for a Council of twenty-five members, six of whom will be doctors to be elected by doctors whose names are on the Register. The Ministerial regulations governing the election process have yet to be finalised. Once finalised, the Medical Council will place notices in the national and medical press and on the Medical Council website. These notices will give details of the nomination process and of the timetable for the election.


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Healthcare Professionals - Crossing BordersAt present there are a number of Sectoral Directives in force on healthcare professionals containing provisions about communication between competent authorities concerning serious matters likely to affect a professional’s right to practise. These include disciplinary action or criminal offences. These provisions have been strengthened by a new Directive 2005 / No. 36 / EC which will replace the Sectoral Directives in 2007.

All competent authorities are required to make full use of the existing provision and towards the end of 2007 implemented the new provisions.

In advance of this Directive, competent authorities across Europe and other stakeholders have agreed to develop a coherent approach to the sharing and exchange of information in relation to healthcare professionals. This process began in the Netherlands EU presidency at the Amsterdam Conference in 2004. Certain problems concerning the exchange of information between competent authorities were identified and included:

n The processes of data exchange;

n The identification and registration of data on professional misconduct.

Following the Amsterdam Conference and during the UK EU Presidency a European wide working group of competent authorities. Government European Commission officials have overseen a project to develop initial recommendations on the exchange of information. These recommendations were presented to the European Consensus Conference in Edinburgh in October, 2005. At that Conference recommendations were modified and endorsed by the competent authorities and other stakeholders which resulted in the Edinburgh agreement whereby the current certificate of good standing would be replaced by a certificate of current professional status.

Since the Edinburgh agreement two further conferences have taken place in Helsinki on 23rd October, 2006 and Berlin on 9th February, 2007.

At the Berlin Conference over 50 regulatory representatives from 13 European countries met to continue progressing the crossing borders initiative.

Arising from the Berlin Conference it was agreed that a common statement on transparent healthcare regulation in Europe should be developed in particular, furthering the availability of information for the public about registered professionals.

It was also agreed in Berlin that a small working group of competent authorities from Ireland, Denmark, UK and Norway should further develop an agreement towards proactively exchanging information when a health professional’s right to practise has been restricted. The working group’s proposals will be put to the next crossing borders initiative meeting which is scheduled to take place in October, 2007.

The Medical Council has been represented at these meetings and conferences by David Hickey and William Kennedy.

William KennedyHead of Professional Standards & Legal Advisor

Education and Training in the CouncilIn March 2006, all five existing Medical Schools in Ireland were visited by a team of assessors, comprising Medical Council members, experts in medical education from within Ireland and from overseas, and a representative of health care consumers. All five schools were accredited as producing competent medical graduates. The Council will be visiting the Medical Schools once again in March 2007, to assess progress.

To assist with this assessment, the Education and Training section have devised a questionnaire for interns, asking them to rate their intern experience. The questionnaires will inform the visiting team during their engagements with the Medical Schools. Enhancing the quality of the intern year is a priority in education and training. The Council’s recruitment of a project coordinator - funded by the Health Service Executive - will be a focus for this work.

Following the recommendations made in “Medical Education in Ireland: a New Direction” (the Fottrell Report) and “Preparing Ireland’s Doctors to meet the Health Needs of the 21st Century” (the Buttimer Report), proposals for Graduate Entry Programmes are currently being considered by the Higher Education Authority. Following this process, the Medical Council will assess the short listed proposals against its standards, which are derived from the internationally recognised guidelines of the World Federation for Medical Education. This process, too, will involve external expert evaluation of the proposed programmes.

The Education and Training section recently arranged an Objective Structured Clinical Examination, in conjunction with the Royal College of Surgeons in Ireland. This examination is the second part of the Temporary Registration Assessment Scheme, which, along with the Multiple Choice Questionnaire, assesses the clinical ability of non-EU doctors who wish to obtain registration in Ireland. Almost 160 doctors undertook the examination over the course of three days. Council appreciates the assistance of the RCSI, and of the other universities in Ireland that have previously hosted this examination.

The Council is keen to keep medical students informed of its role, and recent presentations by Council staff to final year medical students provided a helpful opportunity for information exchange about preparing for internship, the supply of and demand for intern places, and intern registration. The Education and Training section welcomes any invitations to relevant student-related meetings.

Dr. Anne KeaneHead of Education & Training


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Review of the Ethical GuideThe Ethics Committee has commenced the process of review of the Guide to Ethical Conduct and Behaviour and would welcome submissions in relation to its provisions. The Guide is not intended to prescribe a code of behaviour for particular situations but rather to support doctors in reflecting on and making decisions in relation to their practice.

The contents of the current Guide (6th ed. 2004) might be broadly categorised into professional ethics, business ethics and medical ethics, though of course these are not entirely separate and distinct divisions. The first category includes matters common to all professionals such as responsibilities to colleagues, writing reports, misconduct, and referrals. Business ethics includes matters such as setting up practice, advertising, and financial interests in healthcare centres. The category of medical ethics relates particularly to medical practitioners and includes consideration of responsibilities to patients, communication, personal relationships with patients, confidentiality, consent, and beginning and end of life decisions.

In revising the Guide, the Ethics Committee would welcome suggestions as to the structure and content of its provisions in light of particular issues and experiences faced by doctors in

recent years. Submissions may be made in writing or by email to [email protected] and it is also intended to have an online submission facility available on the Council’s website shortly. The current Guide can be downloaded from www.medicalcouncil.ie/professional/ethics.asp and the deadline for receipt of submissions is 7 September 2007.

Dr. Deirdre MaddenChairman of the Ethics Committee

Patient Access to Medical RecordsOver the past few months the Medical Council has received a large number of telephone calls from patients seeking access to their medical records in circumstances where their general practitioner has passed away.

In many of these cases patients have been unable to retrieve their medical records because no provision had been made by their general practitioners for files to be transferred back to the patients or to another doctor.

Doctors, especially general practitioners in sole practice, are urged to familiarise themselves with paragraph 15 of “A Guide to Ethical Conduct and Behaviour - 6th Edition 2004” and make adequate provision for the transfer of patient files in the event of incapacity or death. The current edition of the Ethical Guide can be viewed on the Medical Council’s website:- www.medicalcouncil.ie/professional/ethics.asp

Katie CarrollProfessional Standards Section


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CALLING ALL GPsWe want you to join our team of volunteers

FOR MORE INFORMATION AND TO REGISTER YOUR INTEREST CONTACT THE PERFORMANCE IN PRACTICE OFFICE AT:

1850 211 530 or [email protected]

www.medicalcouncil.ie

Join us in a new initiative that will • ensure ongoing quality healthcare• shape the future of quality enhancement processes

Under a new quality initiative, the Medical Council are piloting a

quality improvement tool, the Professional Practice Review.

We are looking for volunteers in general practice to nominate their

peers and their patients to fill out questionnaires on the service that

they provide.

By participating in this pilot study you will not only gain valuable

insight into your own practice, you will also play a key role in the

development of the quality improvement process for all doctors, and

you’ll earn 3 valuable CME points in the process.

GPs continue to volunteer for Professional Practice Review Pilot100 GPs have signed up on-line for the Professional Practice Review and have been sent out their electronic links and patient packs in the post last week. Out of these volunteers, 22 GPs have completed the process and returned their completed patient packs. These have been forwarded to the Independent Research Company, Pivotal, for analysis. This means that over 500 patients so far have had the chance to give feedback about their GP.

Sign up was initially slow but has steadily increased over the past few weeks, and more volunteers are coming on board every day.

Doctors are signing up by telephone, on line, by post and email and at key ICGP events such as the recent ‘Clinical Update Roadshow’ in Tullamore held on 28th March, 2007.

In addition, some of the GPs who have volunteered and completed the process have contacted Council with comments on the review, including;

n “The online survey was easy to use”

n “Questionnaires easy to complete”

n “Overall experience very good”

n “Patient packs informative and the instructions clear”

n “Ran smoothly on the day.”

n “Patients enjoyed opportunity to give feedback”

If you have been intending to sign up please don’t worry, there is still time to register.

Call us at 1850 211 530, email us at [email protected] or log on to www.medicalcouncil.ie

Dr. Lynda SissonDirector of Performance in Practice


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Doctor contacts office by post, email or phone to register for Pilot Project

Doctor is sent a confirmation e-mail and his/her details sent to independent research company

Doctor is issued a registration link &

&

&

Doctor completes on-line self assessment questionnaire & nominates colleagues

Doctor conducts patient questionnaires on a selected day

Medical & Non-Medical Colleagues are issued link and complete on-line survey

Patient Pack sent to Doctor’s practice

Patient questionnaires returned and forwarded to independent research

company

Independent Research Company evaluate questionnaires

Confidential Report issued electronically directly to Doctor*

Professional Practice Review Pilot ProjectHow does it work?

*For statistical reasons reports can only be issued after the 200th doctor has completed the survey


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KATHLEEN LYNN

Irishwoman, Patriot, Doctor

By Margaret Ó hÓgartaigh, St Patrick’s College, Drumcondra

It may not be widely known that Lynn House, the Medical Council offices in Rathmines, is named after Dr Kathleen Lynn, a significant figure in both the medical and political worlds of early twentieth century Ireland. It is a fitting name for Council offices as she made a great contribution to new medical practices and policy during that time. A recently published biography examines the life of this prominent Irish woman, where she is remembered not just for her achievements as a doctor, but also as a feminist and a revolutionary.

Dr Lynn graduated with a degree in medicine in Dublin in 1899 and was the first female resident at the Victoria Eye and Ear Hospital. In 1919, she established St Ultan’s Infant Hospital with the help of her friend Madeleine ffrench Mullen, which was the first hospital of its kind in Dublin. There, Kathleen pioneered the use of the BCG vaccination over 10 years before it was in general use in Ireland. She also promoted the work of Maria Montessori who visited St. Ultan’s in 1934, and established a Montessori ward in the hospital.

In addition to her contribution to medicine, Kathleen was heavily involved in the turbulent politics of early twentieth century Ireland. She supported the Lock Out of 1913 and subsequently joined the Irish Citizen Army. She took part in the 1916 Easter Rising and was appointed Chief Medical Officer in the City Hall garrison by James Connolly. When the Commanding Officer was shot, she, as next highest-ranking officer, took over the garrison.

She was elected as a Sinn Féin TD to the Dáil for Dublin North in 1923 but refused to take her seat. In 1926 she turned her back on politics

and devoted herself to children’s medicine in St. Ultan’s, running her clinic up until a few months before her death in 1955 at the age of 81. Her hospital is gone today, but during her lifetime she saved and changed the lives of countless people.

This biography reflects the fact that her life mirrored many of the changes and developments in Irish society between 1874 and 1955. A wide variety of issues are dealt with, from suffragism to sectarian politics, education to ecclesiastical subterfuge and the medical profession to spirituality. We are left with a picture of a forward thinking, inspirational woman who made a lasting impression on the struggle for independence, social reform and a progressive medical policy in Ireland.

About the Author:

Margaret Ó hÓgartaigh is a fellow of the Royal Academy of Medicine and was a Fulbright Fellow at Boston College where she taught a course on women on medicine in Ireland and the United States.

Publishers:

Irish Academic Press, Northumberland House, 44 Northumberland Road, Ballsbridge, Dublin 4

Tel: +353 (0)1 668 8244

Fax: + 353 (0)1 660 1610

Email: [email protected]

Website: www.iap.ie

Published: 15th September 2006

ISBN: 0716528436

Stockists: Easons, Waterstones


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Jim McDermott, ICT Manaager

John Lamont, Registrar

David Hickey, Deputy Registrar and John Sidebottom, Senior Executive Officer

Lisa Molloy, Secretary to Council and Claire Lahiff, Clerical Officer

Back to the Shop Floor for Daffodil DayThe Irish Cancer Society annual fundraising event, Daffodil Day 2007, took place on Friday 23rd March. A key element of this vital fundraising campaign is called “Back to the Shop Floor for Daffodil Day”. Back to the Shop Floor invites CEO’s and Senior Managers countrywide to spend some portion of Daffodil Day performing a task that would not normally be part of their everyday routine.

The feedback from the organisations involved indicated that many found this to be an excellent employee relations exercise, fostering fun and inclusion in the workplace while helping to support a great national cause at local level.

This year, John Lamont, Registrar of the Medical Council, and the Senior Management team took on a variety of roles within the organisation i.e. covering reception, sorting incoming and outgoing post, setting up meeting rooms, and filing and scanning of documentation.

In addition, the Senior Executive Officers baked cakes and cookies for the morning tea break, where a donation was required, and a raffle was held to encourage staff members to donate further.

Through the generosity of the members of staff in the Medical Council, I am delighted to announce that we raised €360 to help the Irish Cancer Society provide quality care and emotional support to cancer patients and their families. I would like to thank all who took part and supported Daffodil Day 2007 and we look forward to supporting this very worthy cause again in 2008.

Jan FitzpatrickPerformance in Practice Unit


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MEDICAL COUNCIL PUBLISHES RESEARCH ON DOCTORS AND COMPLAINTS PROCESSManaging Complaints about Doctors: Stakeholder Perspectives of the Role of the Medical Council in Ireland, the first ever report of its kind, was launched on Wednesday 13th December 2006 by the Minister for Health and Children, Mary Harney TD. The study was commissioned by the Medical Council and the Health Services Research Centre at the Royal College of Surgeons in Ireland (RCSI) conducted the research - Ms Siobhán McCarthy, Professor Hannah McGee and Professor Ciaran O’Boyle led the study.

It publishes key findings on medical regulatory issues and identifies their implications for the new Medical Practiti -oners Bill and the broader complaints system. The study surveyed 476 stakeholders, including 35 hospital managers, 250 members of the public, 74 complainants to the Medical Council and 117 doctors complained against to the Medical Council.

The research mainly evaluated how the Medical Council has dealt with complaints under the 1978 Medical Practitioners Act. It did however also test the levels of satisfaction with doctors. 84% of the public surveyed were satisfied overall with the care they received from doctors over the past five years. Complaints about doctors to hospital authorities constituted a minority (15%) of complaints received about hospital services.

While overall there was a high level of satisfaction with doctors, 25% of the public surveyed reported that they did have a reason for being dissatisfied with a doctor over the previous five year period. These mainly concerned consumer issues such as cost, poor communication, etc. The research found that dissatisfied patients were unlikely to make a complaint and there was a very low level of awareness of the agencies responsible for dealing with complaints about doctors.

Some of the problems the research highlighted are rooted in the confines of the Medical Practitioners Act. In particular, the practice of examining all types of complaints under the charge of professional misconduct was identified as problematic, as was the process of corresponding with those who complain and those complained against by standardised legally formulated letters. The result has been that approximately 90% of complaints are deemed not to merit a fitness to practise inquiry, without adequate explanation to or appropriate communication with complainants and doctors complained against.

The study found that this has resulted in negative perceptions of the Medical Council among complainants and has contributed to the belief that doctors are unaccountable. Furthermore, while participating in the fitness to practise process was a largely negative experience for doctors, the problem has been that doctors complained against (83%) have been mostly satisfied with the outcome of the complaint, while the majority of complainants (81%) have been dissatisfied.

A major finding of the study was that both complainants and doctors complained against largely agreed on the changes necessary to bring about regulatory improvements. The research concluded that there was a need for increased transparency, more pro-active systems for monitoring medical practices rather than solely relying on complaints, the need for a standardised inter-agency approach to dealing with complaints and the promotion of better communication skills and interpersonal skills in medical training.

Both complainants and doctors felt that examining all complaints under the charge of professional misconduct was inappropriate. Described by one complainant as “a doctor

breaking a red light and being charged under the Murder Act”, complainants felt that this approach made doctors accountable only for complaints about gross medical errors, which are in the minority. From the point of view of doctors, those who considered their complaints to be trivial or vexatious felt it was unfair to be subjected to a stressful and lengthy statutory process when, in their opinion, it was obvious that a fitness to practise inquiry was not necessary.

Many of the recommendations made in the report have already been taken on board by the Medical Council. Explanatory leaflets for both complainants and doctors setting out the procedures of the Fitness to Practise Committee have been produced for dispatch to complainants and doctors on receipt of a complaint. In addition, the website of the Medical Council (www.medicalcouncil.ie) is currently being updated to enhance the transparency of the complaints process.

The report can be downloaded from the Medical Council’s website - www.medicalcouncil.ie

Alternatively, requests for the report can be directed to:

Ms Lisa Molloy, Secretary to Council,

Medical Council, Lynn House, Portobello Court, Lower Rathmines Road, Dublin 6.

Ph: 01 4983152

Email: [email protected]

Pictured from left to right are Ms Mary Harney, TD, Minister for Health and Children; Dr John Hillery, President of the Medical Council; Professor Ciaran O’Boyle, Head of School of Healthcare Management, RCSI and Professor Hannah McGee, Professor of Psychology, RCSI.


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MEDICAL IONISING RADIATION COMMITTEEDo you know your legal responsibilities when you request x-rays?

In October 2002, the Statutory Instrument ‘SI 478 European Communities (Medical Ionising Radiation Protection) Regulations (2002)’ on the health protection of individuals against the danger of ionising radiation in relation to medical exposures was passed into law. This transposed earlier European directives on the medical use of ionising radiation into Irish law. The SI 478 (2002) embodies principles of good clinical practice in relation to the use of radiology for patient care. The radiologist is referred to as ‘the practitioner’ under this law and those who refer patients for radiological procedures are called ‘prescribers’.

Only doctors or dentists may be ‘prescribers’ under the law and the request must be in writing. Irish law recognises requests by electronic means as equivalent to writing in this respect. It is the duty of the radiologist to determine that the procedure is justified but the prescriber is required to give his or her reasons for requesting the procedure. The prescriber is also required to obtain and inform the radiologist of prior medical records and diagnostic information relevant to the request. How thoroughly do you fill in such information for each and every request for an X-ray?

The law imposes certain restrictions on the use of ionising radiation. Exposures on medico-legal grounds, where there is no direct health benefit for the person undergoing the exposure, may only be performed with a specific written direction from the courts. There are restrictions also on the use of ionising radiation for occupational health surveillance. The law has also required the Medical Council to establish strict directives guiding the use of ionising radiation procedures for medical research.

The prescriber must establish whether a woman of childbearing age is pregnant and record this information on the request for a radiological procedure. If she is, or may be, pregnant, the relative risks of doing the procedure versus the risk of not doing the procedure have to be carefully evaluated. For radioisotope studies, it is also important to establish if a woman is breastfeeding and to take precautions to protect the infant from the radiation risks.

These regulations do not change what has always been good practice in terms of requesting radiological examinations. But it is now the ‘law of the land’ that these principles are adhered to. The next time you are tempted to omit ‘Clinical Details’ or you are tempted not to fill in the ‘LMP box’ on your X-ray or CT request form, remember you may be breaking the law!

Further information on the work of the Medical Ionising Radiation Committee can be obtained on our website at www.medicalcouncil.ie, where the following documents can be downloaded:

‘Dose Constraints for ‘Helpers’ (Comforters and Carers)’ (adopted September 2004)

‘Diagnostic Reference Levels: Position Paper’ (adopted September 2004)

‘Criteria for Clinical Audit’ (adopted October 2004)

‘Protocols for Standard Radiological Practice – Good Practice Guidelines as defined by SI (478) 2002’ (adopted November 2004)

‘Policy Document on the Use of Medical Ionising Radiation’ (adopted February 2005)

‘Radiation Protection 99: Guidance on Medical Exposures in Medical and Biomedical Research’ (adopted April 2005)

‘Radiation Protection 100: Guidance for protection of unborn children and infants irradiated due to parental medical exposures’ (adopted April 2006)

These documents have been disseminated to the HSE and all major hospitals in Ireland.

In addition, the Committee has commenced work on an information leaflet for the general public on Medical Ionising Radiation and a computer-based examination for non-radiologist, medical practitioners who have completed a course in radiation protection and safety.

Dr. Stephanie RyanThe Childrens University Hospital, Temple Street


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Doctors holding full registration:

Irish address Overseas address

Totals of which are Male

of which are Female

Aged 20-35: 3,871 935 4,806 2,339 2,467

Aged 36-45: 3,396 848 4,244 2,771 1,473

Aged 46-55: 2,555 772 3,327 2,418 909

Aged 56-64: 1,432 333 1,765 1,392 373

Aged 65-69: 363 112 475 381 94

Aged 70-80: 512 95 607 473 134

Aged 81-90: 249 20 269 199 70

Aged >90: 15 1 16 13 3

Totals: 12,394 3,118 15,512 9,988 5,524

Registration Statistics 2007 Full RegistrationDoctors holding full registration as at 1 January 2007 by Age, Gender and Address.

Jan July Oct

Total number holding internship registration:

797 820 790

...and are Male 373 399 389

...and are Female: 424 421 401

of which, registered since 1st November 05: 545 564 568

Internship RegistrationDoctors holding current periods of internship registration in 2006:

Jan-06 July-06 Oct-06 Jan-07

Currently Registered: 573 838 773 792

of which are Male: 469 673 627 634

of which are Female: 104 165 149 158

Doctors holding temporary registration

Jan

Total number holding internship registration: 652

...and are Male 299

...and are Female: 353

Internship RegistrationDoctors holding internship registration in 2007

Male

Female

299

353


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Jan July Oct

Total number holding internship registration:

797 820 790

...and are Male 373 399 389

...and are Female: 424 421 401

of which, registered since 1st November 05: 545 564 568

Internship RegistrationDoctors holding current periods of internship registration in 2006:

Jan-06 July-06 Oct-06 Jan-07

Currently Registered: 573 838 773 792

of which are Male: 469 673 627 634

of which are Female: 104 165 149 158

Doctors holding temporary registration

Number of Specialists per Speciality 1st January 2007

Anaesthesia 320Cardiology 72Cardiothoracic Surgery 21Chemical Pathology 6Child and Adolescent Psychiatry 74Clinical Genetics 2Clinical Neurophysiology 3Clinical Pharmacology and Therapeutics 13Dermatology 36Emergency Medicine 52Endocrinology and Diabetes Mellitus 38Gastroenterology 56General (Internal) Medicine 318General Practice 656General Surgery 172Genito-Urinary Medicine 7Geriatric Medicine 53Haematology (Clinical & Laboratory) 48Histopathology 104Immunology 5Infectious Diseases 11Medical Oncology 23Microbiology 37Nephrology 23Neurology 28Neuropathology 3Neurosurgery 16Obstetrics and Gynaecology 110Occupational Medicine 79Ophthalmic Surgery 63Ophthalmology 89Oral and Maxillo-Facial Surgery 9Otolaryngology 56Paediatric Surgery 6Paediatrics 182Palliative Medicine 28Plastic, Reconstructive & Aesthetic Surgery 37Psychiatry 313Psychiatry of Learning Disability 27Psychiatry of Old Age 34Public Health Medicine 72Radiation Oncology 24Radiology 212Rehabilitation Medicine 9Respiratory Medicine 62Rheumatology 33Sports and Exercise Medicine 15Trauma and Orthopaedic Surgery 102Tropical Medicine 1Urology 38Total number of doctors on Register of Medical Specialists 3,798

Register of Medical Specialist


13

Fitness to Practise

Guilty of Professional Misconduct 12

Unfit to engage in practice of medicine 1

Not Guilty/ Fit to engage in practice of medicine/ no case 4

No finding but sanction imposed pursuant to s. 47 and s. 48 3

Outcomes of inquiries in 2006

Inquiries held in 2006 Sanctions imposed in 2006

Completed

Adjourned

No. of Inquiry Days: 20.5

21

1

19

Pending

Erasure

Conditions

Suspension

Advice/Admonish/Censure

No sanction imposed

Total: 19

3

65

4

1

Complaints considered by the Fitness to Practise Committee in 2006

Categories of Complaint

A Alcohol/Drug Abuse/Irresponsible Prescribing H Failure to Supply Medical Records/Reports

B Deputising Arrangements I Certificaton

C Treatment J Other Complaints Considered

D Professional Standard K Advertising

E Responsibility to Colleagues L Convictions

F Failure to Attend M Physical/Mental Disability

G Failure to Communicate/Rudeness P Complaints Unspecified/Unidentified

Misc Miscellaneous

Category

A 15 16 10 5 8 8 1

B 0 0 0 0 0 0 0

C 99 96 70 29 1 95 6

D 93 85 58 33 18 67 2

E 1 2 1 0 0 2 0

F 10 10 8 2 0 10 0

G 28 30 21 7 1 29 6

H 17 15 12 5 1 14 4

I 6 6 5 1 1 5 0

J 15 16 13 2 0 16 3

K 7 4 4 3 0 4 0

L 0 0 0 0 0 0 0

M 2 2 2 0 2 0 0

P 16 13 10 5 0 13 4

Misc 33 9 6 23 0 9 0

Total 342 304 220 115 32 272 26

Complaints

received in 2006

Total Number of

Decisions made in 2006*

Of Which

2006 Complaints

2006 Complaints Carriedover to 2007

PF Case ( Inquiry)

No PF Case**

NPF Case - of which

Withdrawn/Resolved/ Closed


14

Consultants

Non Consultant Hospital Doctors

General Practitioners

Other (Unspecified)

28

10

575

Of the 347 doctors complained in 2006, 111 of these had their names entered on the Register of Medical Specialists. 26 Doctors received more than one complaint in 2006, of which 5 were the subject of a Fitness to Practise Committee Inquiry.

Fully Registered Doctors 15,512

Temporarily Registered Doctors 792

Interns 797

Total 17,101

Complaints Received in 2006 342

Ratio of complaints received in 2006 to number of doctors on General Register

Please note:- some complaints concern more than one doctor

Category of Doctor Number Percentage

Consultants 100 28

Non Consultant Hospital Doctors 18 5

General Practitioners 205 57

Other (Unspecified) 34 10

347 100

Complaints against Doctors

0

50

100

150

200

250

300

Resolved/ClosedNPFPF

2627232

1327619

2006

2005

Decision Number Percentage

2005 2006 2005 2006

Prima facie decision (Inquiry Called) 19 32 6.44 10.53

No Prima facie decision (no case) 276 272 93.55 89.47

NPF of which Withdrawn/Resolved/Closed 13 25 4.71* 9.56

* As a percentage of those were there was no prima facie decision

Complaints considered in 2005 and 2006

Sanctions imposed in 2006

Complaints considered by the Fitness to Practise Committee in 2006


15

Dr John A Hillery (President) (Elected) Consultant Psychiatrist

Dr Colm Quigley (Vice-President) (Elected) Consultant in a General Hospital

Mr Hugh C Bredin (Elected) Consultant in a General Hospital

Dr P A Carney Appointed by the National University of Ireland Galway

Ms Mary Rose Carroll Appointed by the Minister for Health and Children to represent the interests of the general public

Dr Anna Clarke (Elected) Public Health Medicine

Professor Anthony J Cunningham Appointed by the Royal College of Surgeons in Ireland to represent the RCSI Medical School

Ms Mary Gilsenan Appointed by the Minister for Health and Children to represent the interests of the general public

Professor Ian Graham Appointed by the University of Dublin

Members of the Medical Council

Mr J Brendan Healy (Elected) Consultant in a General Hospital

Dr Miriam Hogan (Elected) General Medical Practice

Dr Michael F Hurley Appointed by the Royal College of Surgeons in Ireland to represent the specialties of Anaesthesia and Radiology

Mr Asam Ishtiaq (Elected) Non-Consultant Hospital Doctor

Professor J A Brian Keogh Appointed by the Royal College of Physicians of Ireland to represent the medical specialties

Dr Deirdre Madden Appointed by the Minister for Health and Children to represent the interests of the general public

Dr E P J McGuinness (Elected) Consultant in a General Hospital

Professor Kieran Murphy Appointed by the Minister for Health and Children to represent Psychiatry

Section: Registrar Tel No: +353 1 498 3160 Email: [email protected] Fax No: +353 1 498 3104

Section: Registration Tel No: +353 1 498 3166 Email: [email protected] Fax No: +353 1 498 3102

Section: Education & Training Tel No: +353 1 498 3133 Email: [email protected] Fax No: +353 1 498 3155

Section: Performance in Practice Tel No: +353 1 498 3136 Email: [email protected] Fax No: +353 1 498 3103

Section: Professional Standards Tel No: +353 1 498 3112 Email: [email protected] Fax No: +353 1 498 3103

Section: Finance Tel No: +353 1 498 3145 Email: [email protected] Fax No: +353 1 498 3104

Competence Assurance Advisory Committee: Dr Colm QuigleyEducation and Training Committee: Prof Anthony J CunninghamEthics Committee: Dr Deirdre MaddenFinance and Governance Committee: Professor J A B Keogh Fitness to Practise Committee: Mr J B HealyMonitoring Group: Ms Margo TophamHealth Committee: Dr D SugrueMedical Ionising Radiation Committee: Dr M F HurleyPerformance Committee: Ms Anne MaherRegistration Committee: Dr Ailis Ní Riain

Committee Chairs Management Team

Medical Council Contact Details

Registrar: Mr John LamontDeputy Registrar & Head of Registration: Mr David HickeyHead of Professional Standards & Legal Advisor: Mr William KennedyHead of Education and Training: Dr Anne KeaneHead of Finance: Mr Marcus BalfeDirector of Competence Assurance: Dr Lynda SissonSecretary to Council: Ms Lisa MolloyICT Manager: Mr Jim McDermott

Dr Ailis Ní Riain Appointed by the Minister for Health and Children to represent General Practice

Dr J Conor O’Keane Appointed by the Royal College of Physicians of Ireland to represent the specialties of Pathology, Obstetrics & Gynaecology

Professor William Powderly Appointed by University College Dublin

Professor Eamonn Quigley Appointed by University College Cork

Dr Bernard Ruane (Elected) General Medical Practice

Dr Declan Sugrue (Elected) Consultant in a General Hospital

Professor Arthur Tanner Appointed by the Royal College of Surgeons in Ireland to represent the surgical specialties

Ms Margo Topham Appointed by the Minister for Health and Children to represent the interests of the general public

Registrar Mr John Lamont

Documents

May 07 Edition.indd