The acknowledgement by the president of the Irish Hospital Consultants' Association (IHCA) that the finger of society is now pointed at the medical profession is an important milestone.
Speaking at the association's a.g.m. at the weekend, Dr Colm Quigley said that in the wake of the Medical Council's report into the professional conduct of Dr Michael Neary, the former obstetrician at Our Lady of Lourdes Hospital, Drogheda, doctors must work at maintaining the respect and confidence of patients.
Coming in the same week that Mr Finbar Lennon, medical adviser to the North Eastern Health Board, spoke of the lessons to be learnt from the Neary case, it signals a major change of attitude by hospital consultants in the State.
Dr Quigley told his consultant colleagues that the IHCA recognised its formal obligation to support a system of competence assurance for doctors. Significantly, he said: "the best of us always did". By implication, this was an admission that not all consultants have recognised the importance of maintaining and developing skills during a lifetime of medical practice.
The need for a fully transparent system of competence assurance for doctors cannot be overstated. The days when the public could presume that any professional group "knows best" are long gone. The lessons from the Neary case are clear. Without a rigorous system of peer review, self-audit and a formal mechanism allowing other health professionals to raise concerns about a colleague's competence, such a catastrophe could recur.
To the credit of the present Medical Council, it has been working hard to finalise structures for competence assurance. Doctors must now provide evidence of having attended approved continuing medical education courses. However, we are still some years away from having a system where the actual work performed by doctors is scrutinised on a routine basis. And the profession has yet to accept the ultimate test of competence: a formal procedure of relicensing a doctor's fitness to practise based on actual, rather than presumed, competence.
The Medical Council needs political assistance if better standards are to be achieved. The Minister for Health has promised the heads of a new medical practitioners bill this autumn. He has stated that a new act will include more vigorous and integrated procedures designed to ensure public confidence. It is also expected that the lay representation on the new council will be increased.
However such reform will cost money. A properly functioning inspectorate to implement tougher competence assurance rules will be required. The Government must also commit greater resources to the ongoing education of doctors working in the public health system.
Without additional support, the possibility of future malpractice scandals cannot be ruled out. A change in attitude by doctors while welcome is, in itself, not enough to ensure public confidence in the profession.