1. The Evolving Role of the Physician Dr. John Donohoe, President, RCPI ipha Annual Meeting Dublin, 26 Nov 2008

2. The Evolving Role of the Physician The physician is a member of an ancient profession From the earliest times the role involved the application of knowledge, skill, and experience to the care of an individual patient

3. The Evolving Role of the Physician But an unwritten contract has existed between society and the profession …. position and authority are accorded on the basis that the physician must always place the interest of the patient above self or colleagues

4. Changing World: Society  Changing societal expectations of the medical profession: Access to information (more informed patients and families) and individualisation (focus on the rights of the individual rather than the common good or personal responsibility) Higher levels of education (greater willingness to challenge) Demand for higher standards (communication, immediate response, definitive answers, hygiene, food safety) and intolerance of perceived poor standards.

5. Changing World: Media Media attention to health services –Higher levels of public debate –Focus on the negative –Simplistic analysis –However, dangerous for profession to ignore Media coverage taps into a deep sense of vulnerability that people feel in relation to ill-health, and this fear is very close to the surface

6. Changing World: Events There have been significant incidents of malpractice and incompetence by medical professionals Exacerbated by system failures And amplified by instances of diagnostic failure Despite best practice norms, these are viewed by the public as further evidence of incompetence The “blame game”

7. Changing World: Trust We must acknowledge that there has been a breakdown in trust between the profession and society (though not at the level of the individual practitioner) Can we be trusted to place the needs of the patient ahead of the interests of the profession? This not helped by the fact that most public debate on doctors revolves around contracts, pay and conditions, and ‘scandals’

8. Changing World: Regulation Increased Government regulation and legislation (such as the Medical Practitioners Act, 2007) –Lay majority for the first time –Professional Competence Assurance –Much stricter rules for Registration –Monitored accreditation of education and training

9. Changing World: Trends  Incredibly fast-paced changes in medical practice arising from: demographic shifts (new diseases presenting in Ireland as a result of large-scale immigration; dramatic rise in obesity and the consequences thereof; people living longer with increased levels of co-morbidity and high levels of dependency; inability of families to provide care to ill and elderly) technology and research: new treatments, genetics, stem cells, new surgical techniques changing profile of medical workforce – work/life balance; more females than males entering medical school

10. Changing World: Complexity Increased complexity of healthcare Cost of healthcare and therapeutics Ethical issues – consent, economic considerations Changed profile of medical workforce: work/life balance; more females than males entering medical school

11. Changing World: Response In this changing world the physician must evolve to remain relevant Continuous demonstration of professional competence Increased specialisation balanced with the need for cross-speciality collaboration Less individual ownership of fragments of the patient journey, more cross-boundary, multi- disciplinary collaboration Patient at the centre, always

12. The Role of the Physician Increased imperative for physicians to adopt leadership positions within the health service Increased involvement by physicians in the development of national policy Understanding that leadership and meaningful policy influence results in improved care for all patients

13. RCPI - Influence Clinical Directorates (HSE) Clinical Leadership (RCPI) Professional Competence (Medical Council) Involvement in MET (HSE) The Forum (Training Bodies) provides a coherent, profession-wide voice

14. For successful evolution Physician must engage fully with our changing world The purpose is not to stop change but to influence it positively towards the highest standards of medical training, practice and patient care

15. Evolution, not Revolution! In a highly complex and changing world, the ability of physicians (and the profession) to evolve and involve in a positive way is critical