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Balancing the risks and challenges in medicine

25 August 2015

The keynote address of the Medical Protection Consultants Conference 2015 was given by Professor Freddie Wood, President of the Medical Council, who spoke to the sold out audience about balancing the risks and challenges in medical practice.

The cornerstone of the patient doctor relationship is trust, said Prof Wood, and he showed some research from a series of surveys, carried out by the Medical Council, which consistently rated doctors as the most trusted profession, with an average of around 90% of people trusting them to tell the truth.

He argued that trust and leadership are intrinsically linked, and that the role of leadership in the medical profession is to generate trust between it and the public.

Moving on, Prof Wood addressed the role clinical audit can play in balancing risks for both the patient and the doctor.

“The key component of clinical audit is that performance is reviewed to ensure what should be done is being done, and provides a framework to enable improvements we make,” he said. “Ultimately it is the way of mitigating potential risks, overcoming challenges and maximising benefit to patients.”

He added that objectivity and looking at outcome data and feedback to provide impartial assessment is vital in analysing what you’re doing and finding areas to make improvement in. 

Prof Wood believes that no doctor should care for a patient without external objective sources of information about their progress and the success, or otherwise, of their management or treatment plans.

“It is my view that without clinical audit and external objective sources of information about performance, doctors simply cannot be effective when maintaining their competence in the interests of patients. Doctors should know what they do, how much they do and how well they do it and use that information to improve patient care,” he said.

He used an example from his own career to show how clinical audit lowered his and his patient’s risk, and in fact protected him from an inquiry into his practice.

Prof Wood helped introduce the arterial switch operation to Ireland in 1985, at a time when there were no national or international benchmarks for the operation, which carried a high risk of mortality.

To manage his risk he kept a logbook of everything he did for each operation he performed over 21 years, until he stopped performing the procedure in 2006.

In 2002 he became the subject of a national inquiry, after he had been forced to make a choice between two children as to who would receive treatment as only one intensive care bed was available. Both children were the same age, with the same diagnosis and same severity of condition. The child who received the surgery survived while the other died.

Ultimately Prof Wood was cleared of any criticism, in large part due to the meticulous records he kept.

He told the delegates that in a career spanning over three decades, a doctor can expect to appear in high court, face a claim to the Medical Council, attend to coroner’s court and have a national inquiry into their decision making, which are all experiences he has been through. 

“I firmly believe that were it not for the way I comprehensively looked at my practice, managed data detailing all patients and uplift details in a simple logbook, including outcomes, I would have not been in a position to defend my decision and illustrate my track record. Above all I would have not been able to demonstrate my interest in improving patient care.”

He added that it is important that doctors not be held back by fear of litigation.

“We need to accept that such things will probably happen, particularly in this era, over the course of our career. The best defence would be to improving focus, continuing improvements and a commitment to excellence.”

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