Ron Paterson: Trial by media adds to pressure on GPs

COMMENT

The chairman of the Commonwealth Press Union's media freedom committee, Gavin Ellis, claims that "when a patient feels so strongly that they wish to make their case public they surely have a right to do so".

No one could quibble with that. The issue is whether and how the media choose to respond.

Mr Ellis' statement that "such disclosure is part of the modern climate of patients' rights, informed consent and transparent procedures" is wide of the mark.

Patients rightly expect to be told about disciplinary findings, and the public is interested in stories of misfortune and redress, but unproven and highly prejudicial allegations about individual doctors ultimately serve only the financial interests of media owners.

Doctors do not go to work to harm their patients - British serial killer Dr Harold Shipman was a notable exception - but they are fallible and work in complex systems where mistakes are inevitable and miscommunication is rife.

Stories of medical misadventure and a patient's death or disability naturally arouse public interest and attract media attention, and injured patients and their families often focus on a single health professional involved in their treatment.

Despite the willingness of many doctors to disclose mistakes and say sorry, and the availability of publicly funded complaints mechanisms (advocates and the Health Commissioner), a small minority of disgruntled patients are quick to contact the media.

In practice, journalists turn away far more health stories than are ever investigated or reported, but inevitably a few see the light of day.

Doctors in small communities are probably most at risk because it is much easier for a local reporter to be alerted to their cases, and to find out the names of other unhappy patients.

The publication of allegations of negligence and incompetence before a doctor has an opportunity to put his or her case and have the matter adjudicated is unfair.

Trial by media is a growing trend, which is why I highlighted the issue in the commissioner's annual report. The public expects doctors to be accountable, but there is a risk of unnecessarily undermining public confidence in practitioners and health care by premature publicity.

How is the media to strike a fair balance between legitimate reporting in the public interest and damaging sensationalism? Two sorts of public hearings often attract publicity - coroners' inquests and disciplinary proceedings.

Coroners seem to be undertaking more extensive hearings into unexpected patient deaths, and mental health and obstetric cases are particularly susceptible to extensive media coverage.

The coroner's eventual findings tend to attract far less coverage than the hearing itself. Because coroners' inquests are court hearings, there is a presumption of openness, with limited powers to ban media reporting or to suppress the names of witnesses. A new Coroners Bill will be introduced this year; it needs to give coroners enhanced power to limit the reporting of hearings.

Disciplinary cases are also grist to the media mill. Here, the situation is a little different: there has usually been an investigation by the commissioner, a finding that the doctor breached the code of patients' rights, and a decision by the Director of Proceedings that the matter warrants disciplinary proceedings.

Parliament has signalled (in the Medical Practitioners Act and the new Health Practitioners Competence Assurance Act) that disciplinary hearings must generally be held in public.

In practice, only a tiny number of doctors face charges before the Disciplinary Tribunal (eight this year, compared with 83 in 1994) and recent cases favour interim name suppression until the tribunal makes its decision, and even occasionally following a guilty finding.

There is an important public interest in transparency and accountability in disciplinary proceedings, and name suppression following a guilty verdict should be reserved for truly exceptional cases.

How does trial by media typically occur? A suburban GP found himself named in a newspaper article in September 2002, with the headline "Boy's appendicitis nearly fatal" and a photo of a teenager (showing his scar) and his mother.

The opening sentence of the article stated: "Health Commissioner Ron Paterson is investigating the case of a 15-year-old Wainuiomata boy who nearly died in July when his appendix burst."

In fact, our office had not begun an investigation, but was still assessing the mother's complaint. No journalist checked with our office. The journalist did approach the GP, who at that stage knew nothing about the complaint.

His comments that he was "confident he had thoroughly examined the boy" but in hindsight realised "a review of [his] condition the next day might have been helpful" were reported, but the overall impression created by the article was of a guilty doctor.

The GP later told me the media reporting of the case had affected his professional reputation, self-esteem, and trust in his patients - in stark contrast to the mother's statement that for the GP "this incident is over", whereas her son's health problems continue.

My investigation report exonerated the GP, whose examination was found to be "very good" and overall standard of care "good" (the full report can be viewed at www.hdc.org.nz).

The mother's complaint ensured that the GP's actions would be subject to a thorough, independent review, with an emphasis on learning any lessons from the case. The media publicity created unnecessary additional stress for the GP.

An unhappy patient's decision to waive privacy does not mean that the doctor should be publicly identified.

New Zealand faces a medical workforce shortage. One of the factors cited by doctors giving up practice is hostile media publicity. In fact, most media reporting of health is positive. The media has a legitimate and important role in reporting concerns about the quality of health care, but reporters should aim for accuracy, fairness and balance in their stories.

The issue is not one of a "veil of secrecy", as Mr Ellis claims, but responsible journalism. Premature publicity about cases is unfair, particularly when doctors feel constrained not to comment while the matter is sub judice.

It is also questionable whether the media should give individual complainants an outlet to dispute provisional findings; the legal process should be allowed to run its course.

The public interest is in fair and final resolution of the issues, followed by appropriate remedial action and accountability, if necessary. In short, we need due process and responsible journalism.

* Ron Paterson is the Health and Disability Commissioner.