Hospital consultants cannot just expect or demand the confidence and trust of patients. They must earn it, said the president of the Irish Hospital Consultants Association (IHCA), Dr Colm Quigley.
Addressing members at the annual conference of the association in Limerick on Saturday, Dr Quigley reminded consultants that the Medical Council's ethical guidelines stated that the trust and privilege held by them in the community was founded not only on their knowledge and skill but also on high standards of personal and professional behaviour at all times.
"We must never allow that trust to be undermined," he said. He added that "society's finger" was pointing at their profession, in the aftermath of what he called the "watershed report" of the Medical Council's Fitness to Practice Committee report on the former Drogheda consultant obstetrician Dr Michael Neary. It found him guilty of professional misconduct over the unnecessary removal of 10 patients' wombs.
Dr Quigley said no words from consultants could restore public confidence in the profession. Only actions could. That was why the IHCA was fully committed to the Medical Council's competence assurance scheme, which will ensure doctors' competence is regularly assessed.
"We welcome the formal obligation on all of us to do what the best of us always did: that is to maintain continuing excellence and competence in patient care.
"We must remember that no matter how difficult the working environment is, the public still rightly holds us accountable for the quality of our performance in whatever the setting. The more under-resourced the hospital, the more overcrowded the ward, the outpatient department or the accident and emergency unit, then the more vital it is that the consultant be seen to be on the side of the patient and to be the patient's advocate. Confidence and trust must be won: they cannot be expected and can never be demanded," he said.
He reminded consultants that their ethical duty and contractual right was to speak out about bed closures and other cuts which affected patient care.
"We cannot allow consultants to be gagged by management. Threats of disciplinary action or underhand threats that a consultant's funding priorities will drop down the waiting list unless he or she remains compliant and silent must be resisted," he said.
He said consultants were prepared to accept criticism when and where it was deserved but were not prepared to accept the blame for the shortcomings of a health service which had been under-funded for decades. "It is not the consultants' contracts that have our A&E departments in crisis and patients being treated in car-parks," he said.
He blamed the shortage of acute hospital beds and said reconfiguring hospitals, as proposed in the soon-to-be-published Hanly report, would not change that. "No matter how you reconfigure a litre bottle, its capacity remains the same," he stressed. "Society must accept the responsibility to provide hospital beds and pay for them. . .A society that refuses to put health first cannot call itself civilised."
Dr Quigley said it was difficult to understand how, after a period of rapid economic growth, beds were being closed while patients were being sent to the UK for treatment under the National Treatment Purchase Fund. He attacked health service managers for stifling productivity. It was the norm, he said, that the appointment of extra consultants was conditional on a hospital's throughput of patients remaining the same. He cited a recent appointment in Galway as an example.
"Any sensible business would try and step up its productivity. Not our health system . . . This is insane management. We, along with other medical personnel, want to increase the number of people we treat. We want to shorten waiting lists. The State is acting against us."