Watchdog must hold doctors to their ethics

PUBLISHED : Thursday, 22 April, 2010, 12:00am
UPDATED : Thursday, 22 April, 2010, 12:00am

Health care - and paying for it - is a topic guaranteed to raise everyone's blood pressure. Medical insurance premiums are rising at annual rates considerably above inflation. Insurers say the increases are necessary because some private doctors are abusing the system. It certainly is not hard to find accounts of unnecessary procedures and hospital stays; but while it is good that the companies are calling possible abusers to task, such a role should rest not on the firms' shoulders but with the profession's watchdog, the Medical Council.

To be sure, insurance companies don't contend that the problem is widespread. The vast majority of doctors follow rules and guidelines; but as in any sector of society, there are greedy physicians. Loopholes exist and can easily be capitalised on.

In the case of wayward doctors, this involves overprescribing procedures such as colonoscopies and biopsies. These are investigative measures to detect abnormalities like cancer; a stay in hospital and use of specialist doctors may be called for as well. Such tests can be costly - but are obviously necessary if a serious problem or risk is suspected. But it is also easy to see how a patient could be pushed into needlessly parting with cash for unneeded tests.

It is not that insurance companies are entirely altruistic. They are to be commended for raising the matter and, in some cases, compiling lists of errant doctors. It must be remembered, though, that they also exist to make a profit. Increasingly, they nit-pick and lengthen fine-print exemptions, making the claims process ever-more frustrating.

The sector's ways are apparent as it goes into talks today with health officials on designing a voluntary medical insurance scheme: it complains that the government's insistence that people with existing conditions be covered will be too costly.

Insurers policing doctors is an obvious conflict of interest. They can question claims, but it is not their job to investigate and blacklist members of the medical profession. Physicians' reputations can be wrongly damaged, while there is no avoiding the fact that such accusations can be seen as an excuse not to make payments. The doctor may, after all, be entirely innocent; with patients increasingly suing for perceived negligence, some physicians are taking every possible precaution. It is difficult to know whether a doctor is cheating or simply being overly diligent. Some patients can also be demanding and insist on unnecessary procedures. Others may pester for treatment of the most minor of ailments.

A watchdog exists to keep the profession in check: the Medical Council. Its role is to ensure that doctors uphold the highest professional and ethical standards. Investigating malpractice and taking action against those determined to have done wrong is part of its mission. But the council lacks the independence, resources and structure for credible self-regulation. It has failed to adequately deal with a slew of serious medical malpractice cases over the years. Its regular calls for the government to enable change have all but fallen on deaf ears. Fresh proposals are being put forward and authorities should urgently push them through.

The lack of approval for reform does not absolve the council. It should be maintaining a publicly available list of doctors proven to be carrying out unnecessary medical procedures. However limited its resources, it must make every effort to hold doctors to their ethics. With reform, it will be able to do the job properly. Because the ultimate beneficiaries should not be doctors or insurers, but patients.