Like the Church, doctors will serve their own interests first

THE outpouring of sadness that accompanied the premature death of Vicky Phelan was entirely inevitable, such was the admiration and love everybody felt for the 48year-old mother and health advocate. But her death was also characterised by unusually optimistic expressions of hope that our health system would improve as a result of her campaigning and sacrifice and that women, in particular, would finally receive much better attention and respect in their dealings with the medical profession.

However, in light of Dr Gabriel Scally’s final report following the CervicalCheck scandal this week, it appears that such confidence is almost certainly misplaced.

Dr Scally is clear that real structural improvements have taken place and that most of his 50-plus recommendations have been adopted in full. But, those recommendations, now marked ‘action completed’, represent easy wins and obvious hygiene factors that don’t require any real change in the culture that controls the toxic, unequal relationship patients have had to endure with the healthcare system, the precise relationship that caused the crisis in the first place.

NOW there is a better online guide to CervicalCheck screening, full disclosure about how abnormalities might be missed and two patient advocates have been appointed to the HSE board, which can hardly be regarded as revolutionary.

The idea of a well-resourced patient advocate in every major hospital to ensure equality of arms between patient and all health service professionals is still too much to hope for. Surely it’s a sign of how bad things really were in CervicalCheck that the implementation of mandatory standards, including a much more robust governance and oversight for screening and diagnostic laboratories, are included in the Scally Report as among the recommendations marked completed.

I think we’re supposed to be impressed, when in fact we should be utterly shocked, reminded once again of what a mess CervicalCheck was when even the most basic organisational principles and governance practices were simply ignored. Which meant that women paid with their lives as their smear tests showing clear signs of cancer were misread, delaying treatment beyond the point of no return.

Dr Scally’s report provides convincing evidence that nothing has changed when it comes to the BIG issue – honest disclosure and fair dealing.

The most egregious failure in the CervicalCheck tragedy was the absence of candour on the part of the service and medical professionals, the horrible refusal to inform women that mistakes had been made, the organisational and professional attempt to cover up. And we’d have never known the true extent of this breach of trust were it not for Vicky Phelan’s refusal to sign a gagging clause in her €2.5m High Court settlement in 2018.

However, despite all the trauma, all the hand-wringing, tears, coffins and burials, the Scally Report confirms that almost zero has changed when it comes to disclosing errors to patients. The medical professionals are not for turning.

Even the proposed Patient Safety Bill – which seems stuck in some dark corner of Leinster House to which all awkward ideas are dispatched – only makes provision for mandatory disclosure in limited circumstances, almost all related to the death of a patient. In such circumstances, Dr Scally admits that open disclosure is not possible given the lack of policies and the snail-pace progress of the Safety Bill.

As for his recommendation for doctors to embrace open disclosure and candour, well forget about that one too, given that the Medical Council’s guidelines say doctors should disclose patient information but do not compel them to do so.

Similarly, there has been no progress on imposing a statutory duty of candour on individual healthcare professionals and the organisations for which they work.

Ditto for extending that duty of candour to the individual professional-patient relationship – nothing done there either.

ON THURSDAY Vicky Phelan spoke to us on RTÉ from beyond the grave in that moving film Vicky. And, true to form, she identified the similarities between the Catholic Church and the medical profession as the obvious threat to demands for justice and fair dealing.

Like priests and bishops, doctors put their own interests and the interests of the institution above the welfare of patients. It’s as simple as that.

The fact that some clinicians even refused to treat women who were members of the 221+ advocacy group is indication enough that medical professionals have a problem with their hearing.

They know that they hold our lives in their hands and that’s the kind of power worth hanging onto.