The impact on doctors
But what does all this mean for doctors? Primary healthcare, often the first point of contact, has been hard hit. The Insight Research Group also reported that 77% of UK GPs feel there has been an increase in new cases of mental health conditions in the last four years directly linked to the economic climate.3
Secondary care, too, has been affected, as many patients go directly to a specialist to reduce the costs of additional primary care. Hospitals are run as businesses, as are some medical aids, where they are mutuals and are accountable to their members. As these businesses become increasingly overstretched, tensions can begin to arise between treating escalating patient numbers, reducing costs, and maintaining patient safety.
Dr Graham Howarth, Head of Medical Services (Africa) explains: “We have heard that some private hospital groups, in an attempt to save money, employ nurses rather than midwives on their labour wards, but we cannot comment on the truthfulness of these claims. A lack of specialisation can lead to increased intrapartum problems and the potential for increased complaints or claims.”
A lack of specialisation can lead to increased intrapartum problems and the potential for increased complaints or claims
Acting within your competence is important. MPS has received a number of calls from hospital doctors who feel uncomfortable at being asked to provide cover for an area they do not normally specialise in because of staff shortages.
Dr Ming-Keng Teoh, MPS Head of Medical Services (Asia), explains that some medical private practitioners choose to maintain their income (as patients turn to the public sector) by taking on a wider range of treatments (eg, GPs undertaking cosmetic procedures), as well as patients (paediatricians seeing adult patients, obs and gynae consultants examining patients with breast lumps). Doctors who choose to do this are practising in areas beyond their expertise and may fail to refer appropriately.
You have a professional obligation to work within your competence – and should raise your concerns with a senior colleague or employer if you are asked to perform a procedure that you are unsure of.