General Principles
- Safety of the public must be the chief consideration in dealing with a poorly performing doctor
- A balanced approach should be taken to ensure fairness to the doctor and transparency of process
- At all times, confidentiality should be maintained and restricted to those involved in the process or to those with information pertinent to the process
- The supervising consultant should be involved from the outset with the involvement and guidance from the parent training body, medical manpower manager or clinical director when appropriate. In the case of consultants, the Clinical Director will need to be involved from the outset.
- This guidance does not preclude other separate processes occurring simultaneously eg patient complaining to the Medical Council
- Doctors in training may have alternative processes applied to those not in training via their parent training body.
- Anyone can make a complaint about a doctor who is registered in Ireland. This includes members of the public, employers and other healthcare professionals.
- All steps in the process should be documented for the protection of all particularly the doctor involved.
General Guidance
Poor Performance by a doctor can arise as a consequence of issues of
- Conduct
- Competence
- Confidence
- Health
Different approaches may be required for these different types of problems. In some circumstances, a number of different issues may overlap, for example, poor conduct due to alcohol addiction. Early referral to occupational health should be considered where appropriate.
Conduct
The Medical Council defines professional misconduct as conduct that experienced, competent and reputable doctors consider disgraceful or dishonourable; conduct that falls short of the standards of conduct expected of doctors. Allegations of misconduct should be dealt with under the HSE Code of Conduct for Health and Social Service Providers which may or not may include HSE Disciplinary Procedures. This does not preclude referral to the Medical Council if deemed appropriate. For doctors in training, involvement of their training programme at an early stage is appropriate. If health issues are deemed significant, management of that issue may be the most appropriate means of dealing with issues of conduct.
Competence and Confidence
Issues of competence and confidence may be inter-related. Issues of competence can arise from a lack of knowledge or a lack of clinical skills. Issues of confidence may arise for doctors who cannot translate their knowledge and skills into clinical practice. Issues of competence may be remediable by means of targeted training and issues of confidence by support and positive reinforcement of the doctor. Alternatively, issues of (over) confidence can arise in doctors who perceive their clinical abilities to be greater than those observed by others in that doctor. The degree to which this is remediable will vary. Issues of competence and confidence in trainees should include engagement with the training body if deemed appropriate by the supervising consultant. For non-training doctors, the supervising consultant may seek support from Medical Manpower and Clinical Director if appropriate. Use of the Continuous Professional Development Support Scheme of that speciality parent college may be appropriate for non-training doctors.
Referral to the Medical Council may be appropriate in certain circumstances. This may arise from a serious single event or a recurrent pattern of clinical issues. The Medical Council defines poor professional performance as a failure by the doctor to meet the standards of competence (whether in knowledge and skill, the application of knowledge and skill or both) that can reasonably be expected of doctors practising the kind of medicine practised by the doctor. Referral should be considered if this standard is applicable.
Health
The Medical Council defines a medical disability as a physical or mental disability (including addiction to alcohol or drugs) that may impair the doctor’s ability to practise medicine or a particular aspect of medicine. Doctors with health issues need to be supported to enable treatment and management of the health problem while also protecting the public. Involvement of Occupational Health services will be essential. Other alternatives will include doctor wellbeing programmes of parent colleges and the Practitioner Health Matters Programme. Confidentiality must be protected at all times as doctors with health issues are thus patients, and require the same level of confidentiality as all other patients. Referral to the Medical Council may be required if patient safety is deemed to be at risk. This may arise due to a failure to engage with occupational health services or recurrent issues despite attempts to resolve the health issue.
Referral to Medical Council
Notwithstanding the right of any individual to make a complaint to the Medical Council, if as a consequence of dealing with a poorly performing doctor, patient safety remains an issue despite the approaches outlined above, a decision to refer to the Medical Council may be made after consultation between Clinical Director, Medical Manpower Manager and supervising consultant (where involved).
Notes on this guidance
- It is not possible to predict all possible circumstances that this guidance may apply. This guidance aims to assist decision making but it is not a policy to be used in every instance.
- Alternative approaches may be equally effective depending on the circumstances.
Postgraduate Education and Training MRHT 