News and Education for health professionals

Is it safe?

Regulation of the medical profession is necessary to keep doctors practicing "safely" - or so they say. Dr Joe Kosterich thinks about the role of regulators, and how much bureaucracy is too much.

 I attended an interesting talk about the rise, over the last 30 years, of the regulatory class - comprised of politicians, lawyers, academics, civil servants and parts of the media. Their characteristics include a dislike of private markets, and a desire to make laws and regulations that apply to people other than themselves.

 Their overarching belief system is that all error and all mishap can be prevented if we just pass enough laws and make enough hoops to jump through. A crisis helps but failing that just play to safety fears.

 Revalidation is supposedly coming because the Medical Board is facing the challenge of how to keep doctors practicing “safely”.

 On what evidence basis are we saying it is not safe? I am not talking about the fact that, like in all forms of human endeavour, mistakes are made or that a handful of individuals are below par. Where exactly is the evidence of a systemic lack of safety, requiring a systemic approach to fix?

 It is easy to set up straw men with references to lack of safety and get governments to agree.

 Vocational registration and accreditation are about ensuring high standards of practice are maintained. There is monitoring by the Professional Services Review, Health Insurance Commission, Colleges plus federal and state health departments.

 All the above-mentioned monitoring is supposed to pick up “problem” doctors. Is this all useless? And if so will it all be disbanded when the new regime comes in? Or will we get another layer of bureaucracy?

Where exactly is the evidence of a systemic lack of safety, requiring a systemic approach to fix?

 Given the professed love of evidence by our regulatory masters, where is the evidence that a system of routine re-credentialing makes a difference? Can we point to a double-blind trial or statistics from countries which have done this to show improved health outcomes?

 The cost and logistics will be huge. Every doctor will need someone looking over their shoulder. It will be like one giant circle. Unfortunately, there may not be anyone left to diagnose or treat patients.

 Maybe that is the plan. This would cut health costs and if no doctor does anything, no doctor can do anything wrong. It is a much easier job to be an assessor criticising others than to actually manage patients. And we will need thousands of full time assessors all with note pads and pencils.

 Medical practice requires judgment and this is more than ticking boxes. When Q tells James Bond in Skyfall that sometimes agents are still needed in the field to pull the trigger, Bond counters - “or not”. The regulatory class doesn’t get that because they never make decisions which they are personally accountable for. Bond also fails re-credentialing but demonstrates that capacity to do the job is not the same as capacity to pass some test.

 But I am too harsh.

 We should all just go along - on one condition. That a re-credentialing body be set up to make sure that regulators continue to regulate safely. I will personally volunteer my time to chair such a body.

Simon CowapDr Joe Kosterich MBBS
Doctor, speaker, author of three books, media presenter and health industry consultant, Dr Joe Kosterich wants you to be healthy and get the most out of life.

He is a regular on Channel 9 and radio, writes for various medical and mainstream publications, as well as maintaining a website and blog providing health information. He is the health ambassador for locally grown fresh potatoes. Dr Joe also gives practical motivational health talks for the general public and organizations.