As a Medical Protection member and with a background in general practice, Dr Ian Lavelle shares some insights from his first year as a Medicolegal Consultant – including what he wishes he’d known as a working GP.

I started working as a Medicolegal Consultant at Medical Protection in January 2021. Prior to that I had been working full time in a general practice in Dublin. I completed my vocational training in general practice on the Midlands Training Scheme in Tullamore. As a GP and a doctor who has been indemnified by Medical Protection throughout my whole professional working life, I was never fully aware of the scope of resources that Medical Protection offers. I thought it might be helpful at this stage to provide some advice and tips on what I’ve learned, and what I wish I had known about Medical Protection while I was working full time in general practice prior to commencing my new role.

While Medical Protection’s primary role is the provision of medical indemnity and medicolegal advice, there are many additional benefits of membership. Medical Protection also plays a valuable role in advocating for doctors in an increasingly difficult and challenging healthcare working environment. In the past few months, we have written to the Minister for Health asking him to delay the implementation of the measures within the Patient Safety Bill that would introduce mandatory open disclosure for individual doctors, as they wouldn’t have sufficient time to engage and have appropriate training to comply with the new measures whilst coping with the pandemic. Responding to public consultations – launched by the Department of Health and other organisations – is also part of the advocacy work we do on behalf of members. We are currently working on our response to the public consultation from the Medical Council as part of a review of the Guide to Professional Conduct and Ethics for Registered Medical Practitioners, aimed at providing appropriate guidance of professional conduct for doctors. 

As a member I had never fully availed of the benefits of membership. Through my new role I have been introduced to, and will shortly starting working on, the telephone advice line, which provides 24/7 urgent medicolegal advice to members. In addition, Medical Protection’s press office also provides 24/7 media handling support to members. One of my tips would certainly be to have a look at the Medical Protection website and familiarise yourself with the full benefits of membership of Medical Protection. It’s reassuring to know these benefits are available to you should you ever need them. 

Keeping us up to date

With regards to membership, I would highlight the importance of ensuring you keep your membership subscription up to date. The indemnity Medical Protection offers to individual clinicians is based upon the principle of discretion. This provides the flexibility for us to provide assistance in situations when a tightly-worded insurance contract may have precluded help. As long as you are undertaking work that falls within your category of membership and you have a subscription appropriate for the type and frequency of work you are doing, then you can request assistance in the usual way. 

Issues can arise, however, where a subscription has not been kept up to date. This might happen if a doctor were to forget to update their membership category when transitioning from a non-consultant hospital doctor (NCHD) to a GP registrar for example, or when commencing a new procedure that was not included in their previous subscription. It is vitally important to keep your membership category and subscription up to date to avoid any potential issues should you require assistance. I feel therefore that this is an important aspect of membership to highlight.

Lessons for clinicians

With regards to clinical practice, if I were to pick one aspect to highlight it would be the importance of keeping accurate contemporaneous records of all patient interactions, including any important positive and negative findings and clear safety netting. I understand GPs in Ireland are perennially overstretched and short on time. It’s worth remembering, however, that our clinical notes are heavily relied upon in processes such as regulatory investigations and claims. I have been involved in cases where it is obvious that clinical care has been provided to a high standard, but due to a sparsity of documentation this is unfortunately not reflected in the clinical records. Being able to refer to accurate and clear contemporaneous notes is very helpful in defending spurious claims and in assisting with Medical Council complaints, inquests and other processes should they arise.

In a similar vein, I would also highlight the resources available to Medical Protection members through the PRISM online learning portal. Through this portal you can access free online courses to help develop your knowledge and skills in many important areas such as medicolegal issues, professionalism and ethics, communication and interpersonal skills, systems and processes and clinical risk management. Developing your skills and knowledge in these areas will help to reduce the risk of being faced with time consuming and stressful processes such as Medical Council Complaints and claims. These resources can be accessed at any time via our website, medicalprotection.org, and you are also entitled to include them in your CPD point requirements once completed.

Another useful resource I would highlight would be the Medical Council’s Guide to Professional Conduct and Ethics¹. Although perhaps not recommended holiday reading, at roughly 50 pages long it is easy to refer to, and it provides helpful and practical regulatory guidance on a very wide range of challenging issues that frequently arise in the practice of medicine. It is a document that I now refer to every day in my new role. I would have referred to it much more frequently in my work in general practice had I been more familiar with it. 

Your health and wellbeing

The final area I would highlight is the very important area of health and wellbeing of doctors. There is no doubt that the COVID-19 pandemic has placed a huge burden on general practice. It is also clear that general practice has played a vital role in keeping the wheels of the health service turning in the face of the unprecedented difficulties presented by the pandemic. This selfless hard work and dedication to our patients has been very evident in the recent COVID-19 vaccine rollout through general practice. 

The rollout has been incredibly successful in providing vaccination to many of our most vulnerable patients. This success has not happened by accident. It is thanks to the sacrifices of the doctors, nurses and administrative staff of general practices all over the country who have worked late evenings and weekends, in addition to keeping their busy daytime practices and services running throughout the pandemic. 

Needless to say, the past 21 months have been incredibly stressful and challenging. It is more important than ever to remember to prioritise our own health and wellbeing, just as we prioritise taking care of our patients. Indeed we have an ethical responsibility in this regard as outlined in section 58.1 of the Medical Council’s Guide to Professional Conduct and Ethics¹, which also states that you should not treat or prescribe for yourself, and should have your own GP who is not a member of your family. As a member of Medical Protection, you have access to Medical Protection’s Wellness Hub, which is available via the Medical Protection website. This is alongside the offer of a free, confidential counselling service for members experiencing work-related stress. In the times we are living I believe it is worth highlighting these further resources in the crucially important area of doctors’ health and wellbeing.

If you have any medicolegal concerns or would like advice on a specific matter, please contact Medical Protection for advice. Medical Protection has many years of experience in Ireland and, since March 2020, we have a team based in Ireland, who have local knowledge and expertise. 

¹Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners (Amended) 8th Edition 2019