Bad Doctor (2)

By Jim McVeagh 06/12/2009

Ron Paterson, the former Health and Disability Commissioner, is going to head up a research project into “the best practice on how the public can be confident any given medical practitioner is “a good doctor”“. While this sounds superficially like a worthy undertaking, you can be assured that the conclusions arrived at will probably be erroneous and lead to unnecessary and onerous restrictions on doctor’s practices. The reason I say this is simply because it is not research being undertaken by someone with a true understanding of the complexities of medical practice. True, Ron Paterson is better equipped than the average lawyer, having spent a decade in the HDC, but that is like chairman of the DHB is able to judge how good a heart surgeon is because he has spent years planning a new cardiovascular suite.

Unfortunately, the HDC is not a good place to be able to judge a doctor’s skill. The HDC focuses solely on the interpretation of the patient bill of rights. Occasionally, this does include judging a doctor who has not provided optimum treatment, but, as I have said on multiple occasions on this blog, a doctor who makes a mistake or takes a dodgy short cut is not necessarily a “bad doctor”. He is often a tired, overworked doctor. She is often a doctor lulled into complacency by 5000 similar cases that have all been trivial. Often the doctor in question is taking the rap for a badly flawed system that allows compounded errors to cascade into disaster.

The number of doctors criticised by the HDC for their management of patients runs into the hundreds. Less than a dozen of these had been actual “bad doctors” – doctors who are incompetent rather than temporarily negligent or simply overwhelmed. It is therefore questionable whether someone of Ron Paterson’s experience can competently judge the methods by which doctors assess their skill sets. Especially when he makes a statement like this:

“… there’s good reason to think the vast majority of doctors practise competently and keep their skills up-to-date. Although the Medical Council is required to ensure the fitness and competence to practise of individual doctors, the way in which they do that is still fairly light-handed … At the moment there’s a fair degree of self-assessment.” [Emphasis mine]

Anybody pick up that the man who is about to “research” the assessment of doctors is starting with the preconceived notion that it is too “light-handed”? Does anyone actually think that this “research” is going to show anything except deficiencies in the system? And this is despite the fact that there is every indication that the current system is working fine. Paterson himself found very few doctors who were truly deficient in their medical knowledge and skills. Medical council rarely has to strike a doctor off the register and even that is usually for misconduct, rather than incompetence.

There is also no evidence that other countries with stricter registration and competency procedures have any better medical workforces. On the contrary, New Zealand is often acknowledged as having one of the best training systems in the world. New Zealand trained doctors are highly sought after.

One of the main problems with all of this talk about “league tables” for doctors and web sites comparing practices, is that patients are judging by non-clinical criteria. To the average lay person, a good doctor is one who listens to their complaint and who has a pleasant manner. It is automatically assumed that the treatment will be of an adequate standard. Contrast the concerns of a clinical assessment regime , which is more concerned with the doctor’s knowledge and clinical procedures and skills. The two are poles apart.

Therefore a revamped clinical skills assessment will be essentially meaningless to the average person. Yes, people want to be assured that the doctor they are seeing is competent, but that is clearly already reasonably assured. The vast majority of complaints about doctors have absolutely nothing to do with their skills. Bad doctors are already very, very rare. While the current assessment system might benefit from an increased frequency of spot checks, to ensure that doctors are actually doing all their Continuing Medical Education, there simply doesn’t seem to be a pressing need to have a more elaborate, more intrusive system.

But I am willing to bet that Ron Paterson will be recommending one.


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