Editorial: Patient input can only help doctors

Any scheme with the potential to improve the delivery of medical care and enhance public safety is to be applauded, the more so if that initiative comes from the medical profession rather than being imposed on it at the taxpayers' expense. Such is the case with a one-year pilot scheme being tested by the Medical Council, which is designed to provide doctors with a snapshot of their practices through the eyes of those they work with and the patients they serve. The programme will tell them where they need to do better. But it is not something the Medical Council should be overselling.

There is, for example, little likelihood that the programme will pick up offenders such as Morgan Fahey, the Christchurch GP convicted in 2000 of sex crimes against female patients. To suggest as much probably reflects the profession's defensive attitude towards such incidents. The scheme will, in fact, concern itself with the more everyday fare of medical practice, as might be expected of an exercise triggered by doctors' failure to keep up with the requirement for ongoing medical education. Patients will rank doctors on communication skills, patient satisfaction, having their questions answered and the clinic's staff and facilities. Doctors' medical colleagues will rate them on the likes of clinical competence.

There are a number of factors that impose constraints on the process. First, the absence of random sampling removes one of the most potent of ranking weapons. Second, only a small number of patients will be sampled. Doctors are required to collect just 20 signed consent forms from patients willing to take part in the evaluation, from which the council will choose 10 to survey confidentially.

Potentially that also allows doctors to influence which patients will be surveyed, and to select only those who they believe will provide a positive view. Patient confidentiality is another possible bugbear. Many patients may be loath to express an opinion about their doctors in case it gets back to them.

Some doctors have criticised the scheme as an unnecessary addition to the professional development requirements of the medical and surgical colleges. Some go so far as to say it will deter doctors from going into general practice. That is an overstatement. Experience with a similar scheme in Alberta in Canada suggests that doctors will warm to it over time. As they should. The act is a commendable attempt to act before complaints are received. At the very least it demonstrates that doctors are prepared to be audited, and to involve the people they serve.

Already, however, there are adequate means for the public to report serious offences by a particular doctor. Complaints can be forwarded to either the Medical Council or the Health and Disability Commissioner. Generally, the system has worked satisfactorily. Twelve doctors have been struck off the medical register in the past five years, and 51 found guilty of offences by the Medical Practitioners Disciplinary Tribunal.

The value of the scheme will probably lie in pinpointing doctors who have difficulty communicating with their patients, or who do not answer questions with sufficient clarity. That, certainly, appears to have been the major benefit in Canada. Today's patients are far more knowledgeable and far more questioning. Tools such as the internet mean they are less likely to take a doctor's word. This might be discomforting to some GPs, and add to the workload of others. But it is also a fact of general practice today.

The scheme's ambition is, in reality, fairly modest. Claims about the apprehension of GPs guilty of repeated malpractice can be discounted. That, indeed, was never the aim of the Alberta programme on which this is modelled. But that does not invalidate it, or make the Medical Council's initiative a waste of time and resources. Doctors have not always been at the front of the queue in cultivating better relations with their customers. This is a step in the right direction.