Law forcing doctors to go on defensive

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DOCTORS WERE resorting to defensive medicine in the face of confrontational and litigious patients who had lost faith in the medical profession, the country's chief medical regulator said last night.

Sir Donald Irvine, president of the General Medical Council, the doctors' disciplinary body, said a major change in the regulation of doctors to ensure they maintained high standards and protect patients from poor practice was required if public trust was to be restored.

In defensive medicine, patients receive sometimes unnecessary and aggressive treatment to avoid a charge of medical negligence. The implication of Sir Donald's comments is that if there were greater trust in doctors the pressure on them to treat defensively might recede.

On the eve of a vote by the council today on a proposal that every doctors' right to practise should depend uponpassing regular checks of their competence throughout their careers, Sir Donald said there was a realisation within the profession that "British medicine must be changed utterly".

He was speaking yesterday at the launch of a book, Medical Mishaps, by Linda Mulcahy, to which he has contributed a chapter, at the Kings Fund in London. In the book, he states that patients have been demanding to know how they can be assured that "the doctor they will see next week at the surgery or the hospital is really up to date and on top of the job".

Patients were seeking a less dependent, more evenly balanced relationship with their doctors, which some welcomed but others found difficult and demanding. "Across a broad spectrum of the profession there is a general anxiety that we may be drifting towards a more confrontational and litigious climate in Britain in which defensive medicine becomes part of everyday practice," he said.

Sir Donald, a former GP in Northumberland who has been president for two years, hascampaigned to reform the regulation of doctors in the wake of high-profile cases, including the Bristol heart babies disaster and the Kent gynaecologist who injured scores of women, which have fuelled public discontent.

The cases exposed the arrogance, insularity and lack of accountability of some doctors and the fact that after completing training there were no further checks on performance.

Doctors have also come under pressure from the Government, which is seeking to take powers under the NHS Bill to alter regulations governing their registration.

However, Sir Donald's efforts to deal with these twin pressures suffered a setback last November when the 104-member council accepted the principle of regular checks but refused to agree that those who failed them should be struck off the medical register.

A steering group was set up to examine the process of "revalidation", and in a report last week it said it must be linked with continued registration. In place of exams, which were rejected, the checks would involve drawing up performance "profiles", including targets to be met and a record of participation in clinical audit, which would be monitored by external assessors.

Doctors who failed the checks would be offered advice and retraining or, in more serious cases, be dealt with formally under the GMC's performance procedures. Striking a doctor off the register would be the ultimate sanction.

Sir Donald has staked his reputation on the outcome of today's vote and if the reforms are rejected he could be forced to resign.

If the vote is carried, asexpected, it will usher in the biggest change in regulation of doctors in more than 100 years.