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When doctors differ and patients suffer

County View

County View
John Healy

That old half-jest that nowhere is more dangerous to be sick than a public hospital was given a shot of credence by the president of the High Court in recent weeks.
Suspending a junior doctor from practice following serious reports of his lack of basic medical competency, Justice Peter Kelly voiced his concern about defective procedures for recruiting doctors for work in Irish hospitals.
Judge Kelly’s challenge to the HSE to offer an explanation of its recruitment procedures has put the spotlight on what many in the medical profession regard as a shambles. The judge himself referred to previous cases he dealt with where registered doctors ‘with little knowledge of the basics of medicine’ were recruited to work with the HSE. It is a situation which in turn raises the question of why junior doctors are in such short supply that hospitals – as is quite obvious – are prepared to cut corners and dispense with fundamental checks in order to fill hospital vacancies.
Much of the problem has its origins in the recognition in Ireland of foreign qualifications, which is reflected in the number of cases involving overseas doctors coming before the Medical Council by way of complaint. In many east European countries, doctors are allowed to graduate with little or no hands-on hospital experience. Such was the situation in the more recent case, where the doctor was appointed to a hospital maternity unit even though he admitted never having been taught how to examine a pregnant woman.
But, as Justice Kelly pointed out, this was no isolated case. Two years ago, a Sudanese doctor was removed from on-call duties when it was discovered that he was unable to distinguish an ankle from an elbow on an x-ray. Incredibly, he went on to be employed by three other hospitals. A Romanian doctor, who had failed an exam for a job in her own country, was taken on as a senior house officer at Letterkenny Hospital. It was only when her colleagues noted that she did not know how to take a patient’s pulse that the lack of initial vetting of her job application became apparent. A Finnish doctor, absent on sick leave in his own country, was taken on as a pathologist at UCHG, but was subsequently found guilty of professional misconduct by misdiagnosing cancer patients.
An ancillary problem is that of language competency and the ability of foreign doctors to communicate in English. Many hospitals admit to turning a blind eye to English-language tests, a situation which is readily apparent in A&E departments up and down the country. Nowhere is the potential for error, with disastrous consequences, more evident than when a foreign doctor (albeit benignly) struggles to engage in dialogue with an elderly, confused Irish patient, to say nothing of the nuances of local idiom and expression. All too often, were it not for the interpreting skills of the attending nurse, the resultant level of misinformation could be lethal.
Justice Kelly’s alarmed comments on the situation are, however, unlikely to inject much of a sense of urgency at official level, if the response of the Minister for Health is anything to go by. Speaking on the RTÉ news, Minister Simon Harris blithely pointed out that, lest anyone point a finger at him, ‘recruitment was the responsibility of the HSE’.
And in a jaw-dropping playing down of the crisis, the Minister explained that the most-recent case only went to show how well the State regulatory system is actually working, and that incompetent doctors are soon flushed out.