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The ethics of medical performance

Blog 24 June 2013

Tony Falconer, RCOG President

Dr Tony Falconer, RCOG President, writes…

Today at our biggest World Congress yet being held in Liverpool, I will speak about the role of ethics in obstetrics and gynaecology and what this means for both us as a profession and for our patients.

As a specialty we deal with many ethical issues on a regular basis such as genetic screening and the boundaries of assisted conception to name a couple. We struggle with these topics but always try and do our best for our patients and their families.

However, we are missing the most fundamental challenge of all – ensuring that our patients receive the best possible care at all times of day or night. Is this not our greatest ethical challenge of all?

So what are the pressures that can distort these honourable objectives? Financial pressures, employment contracts and hours of work, workforce challenges, legal issues, political pressures and public expectation, to name but a few. The Nicholson challenge for example has created huge tensions in our publically run NHS. In addition, hours of work and the pressure of the European working directive may improve performance due to lack of fatigue but lessen continuity of care with impacts on patient care and training experience.

We are now entering a new period of medical history with a welcome emphasis on assessment, accountability and regulation of clinical performance, both of individual doctors and Trusts.

Furthermore in light of the Francis Inquiry, the profession is now seriously questioning basic professional values around patient care and performance.

The introduction of revalidation last year is an important step and I was involved in the setting up process. The central pillar of this will be the appraisal and objective assessment. A greater rigour and objectivity is required if we are to regain the confidence of the public that this process is meaningful.

So what are our strategies to reduce the problem of poor performance? The RCOG suggests that the following elements are central to the issue of improving performance, including clear leadership, outstanding metrics, a clear evidence base, quality training and assessment, lifelong learning, embracing new patterns of care and close team working with professional colleagues.

We also strongly support the concept of senior, 24 hour consultant presence on labour wards. This can only be achieved realistically by reconfiguration in the current economic climate.

In conclusion, these challenges around performance have always been with us but never under such a spotlight. After 40 years in medicine, I have been heartened by the desire of all doctors, experienced and in the training grades, to give the patient the best care possible, but we are all human and performance can vary from day to day. But the openness and desire to deliver safe, high quality care, based on evidence that is acceptable to the patient, the three principles described by Lord Ara Darsi have improved the quality of performance.

I hope and believe that the leadership of our discipline and the RCOG will continue to strive to improve the quality of care for all women both in the UK and indeed globally but it can only do this with full cognisance of the ethical values that are so fundamental to us. These elements are enshrined in our recently released Manifesto, containing our commitments to patient care as a result of the Francis Inquiry. I hope our community will embrace the current opportunities to raise the quality of our performance for the women we all serve.

To read Dr Falconer’s full speech, ‘The Ethics of medical performance’, please click here.

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