Just How Healthy Is Your Doctors’ Working Practice?

If you have a medical concern and you think you might need like to consult with some-one else perhaps that second opinion isn’t worth the bother.

In a survey by the prestigious University of Cambridge it was found that a quarter of doctors who knew that one of their colleagues was underperforming or otherwise failing to meet their professional obligations would not bring the matter to the notice of their superiors or regulatory bodies.

There are a number of reasons that add to this inaction: they fear retribution, they don’t believe that any significant action will be taken or they assume that some-one else is dealing with the matter and so let it pass without mention.

Just How Healthy Is Your Doctors' Working Practice?

The survey was conducted confidentially and found that in a dataset of 3000 British and American doctors one fifth of them had direct experience of a colleague who they believed to be incompetent or sub standard within the past three years. 21% of the American and 13% of the British doctors admitted that they failed to pass their feelings on to the patients who were under their care about their, or their colleagues’ mistakes for fear of being taken to court and/or risk being struck off of the medical register.

Niall Dickinson, chief executive of General Medical Council (GMC), the British body charged with making sure that doctors perform to the patients’ best interests said, after reading the survey that: “Doctors have a clear duty to put patients’ interests first and act to protect them,” including reporting other doctors to the GMC when they feel they have witnessed malpractice or negligence.

In Britain at the moment there is heated debate about how the National Health Service should be run. The coalition government is trying to put forward plans where GPs will take authority for where money goes while also being incentivised to make cuts in spending by recommending cheaper care wherever possible. Cheaper care might not be the best for the patient but it would be beneficial for the government which is currently trying to cut spending everywhere they feel it is possible.

Now that it is possible for patients to get detailed information about their own conditions their current treatments and success rate of various health authorities as well as recent health scandal and the rise in middle management taking control of budgets.

Statements such as those contained in the US/European Charter On Medical Professionalism, Doctors in Society and those made by the GMC all point to the primacy of patient care overarching all other financial and administrative concerns which could be prejudicial to the wellbeing of the patient. They further maintain that patient welfare includes avoiding discrimination against patients on any grounds and acting with integrity and honesty. Professional behaviour is defined as avoiding conflicts of interests, providing high standards of care and ensuring that activities which allow for quality improvement are actively pursued. They further encourage all doctors to pursue a culture where limited resources are justly distributed.

Of course the great majority of doctors agreed with these statements and their normative values and similarly the majority regarded behaviour which jeopardised these core values as something that should be reported, however, in practise these issues were reported infrequently and when they were reported doctors were more likely to report them as happening ‘sometimes’ as opposed to ‘often.’

Almost every doctor said that they had made improvements to their best practice in the previous 3 years as a result of the practice guidelines, British doctors were more likely to have participated in the drawing up of these guidelines for the development of practice rather than simply adhering to recommendations which were placed upon them.

Doctors were far less interested in getting involved with quality improvement activities, while doctors agreed that they aught to be getting involved in peer reviews of care provided by their colleagues only just over half had taken part in reviewing their co-workers’ records for the pursuit of quality control. British doctors went along with formal medical error reduction programmes while US doctors preferred a periodic system of recertification exams in order to guarantee clinical excellence.

British doctors preferred to keep some of the details of the risks and benefits to themselves rather than making full disclosure to the patient, however, if things didn’t go to plan it was also the British medics who were significantly more likely to disclose all of the medical errors and complications to the afflicted patient. More US doctors reported that they hadn’t disclosed an error to the patient at some time in the previous year for fear of being sued. (12.7% of British medics compared to 21.4% of American doctors)

Patient autonomy was endorsed by all doctors, few declined to prescribe a brand-name drug when the patient asked for it or refused to make a referral when the patient asked for one, even when the doctor felt a second opinion was unnecessary. It is here where conflicts may arise between the side encouraging cost effective client care and that encouraging patient autonomy. Today it’s possible to find out the most cutting edge treatment for any illness and specifically ask for it no matter how expensive the treatment may be. Factors such as race and religion should be utterly transparent when it comes to provision of healthcare services, (or so 88.7% of British and 84.2% of American doctors thought) although fewer than 20% had actually looked at the data that was available on health inequalities in their own practice.

In a surprising revelation of attitudes only 80% of doctors either side of the Atlantic agreed strongly that patient care should come above the doctors’ own financial interests. Americans were more likely to accept potential conflicts of interest and more likely to believe that a business relationship was the most appropriate, they were more likely to report actual business relationships with patients and also more likely to accept gifts and inducements from pharma’ companies.

The bottom line is this: You should take responsibility for finding out all you can about any conditions you’ve been diagnosed with, look into the best treatments and propse them to your doctor. The mentality that “Doctor knows best” has had its day and an individual’s insight into their own condition can be more valuable than the expert’s.

Dan Cash hasn’t been to a doctor in over two decades and puts his health down to taking vacations at spa holidays in Europe and beyond. If you can afford it, try the Ananda in Himalayas, there really is nowhere else like it on Earth!

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