Let the right one in

HIPPOCRATES OF KOS writing around the 5th century BC offered this advice on dealing with patients:

"…Perform all [these duties] calmly and adroitly, concealing most things from the patient while you are attending to him. Give necessary orders with cheerfulness and serenity, turning his attention away from what is being done to him; sometimes reprove sharply and emphatically, and sometimes comfort with solicitude and attention, revealing nothing of the patient’s future or present condition."

Though he has been called the father of Western medicine just what do you think a GMC fitness to practise panel would make of his approach to patient consent? Not to mention a civil or criminal court in regard to a potential claim of clinical negligence or assault.

In a recent presentation to MDDUS staff on risk assessment I displayed this quote from Hippocrates and posed the question: Would we want him as a member?

Of course this is completely unfair to the philosopher – judging him by the ethical and clinical practice standards of today. I was only making a point about how we as an organisation ensure that a doctor or dentist applying for membership represents an acceptable risk to MDDUS and its existing members.

And this is, indeed, a matter of importance to all MDDUS members. Remember that as a mutual organisation all members contribute equitably to a large fund which is maintained to provide legal support and indemnity. Our mutual status frees us from the need to pay dividends on cash surpluses and as such we have no profit motive.

This means that the MDDUS Board and management are in effect trustees of that fund and must ensure the organisation carefully assesses who can be allowed to join and potentially call on our joint resources. We do not want to put the fund at risk from applicants who show a high likelihood of making calls on it at a significantly greater frequency and cost than a typical member. This leads us to the principle of risk assessment.

Risk assessment is, in broad terms, the process by which we decide to accept a risk and the conditions under which we would agree to accept it, including – in the case of a membership application – the subscription rate we need to charge in order to accept that risk.

MDDUS does not accept into membership anyone who applies regardless of what is disclosed on the application form. Viewed from a risk management perspective, the membership application form is the prime mechanism by which we assess risk exposure and consequently accept or reject the risk posed by an applicant.

Our membership and advisory teams scrutinise all application forms and assess them on various criteria. The risk assessment takes into consideration factors such as previous claims history, criminal convictions and disciplinary proceedings. We do take steps to help distinguish between serious and frivolous or irrelevant claims or complaints. Our obligation is to use a model which is effective in predicting the likely threat to our funds.

An obvious example of an applicant posing significant risk might be a surgeon working in private practice with a history of numerous expensive medical negligence payouts, or a dentist with serious disciplinary and clinical failings that have been upheld by a fitness to practise panel. All such applicants must be judged on an individual basis by MDDUS.

Over the last couple of years we have seen significant advances in the development of our new, integrated computer systems. These systems have helped modernise what we do and helped add greater efficiency to our risk assessment processes. The systems also allow us to interrogate past data and check that consistency and equity are applied to all prospective applications.

There needs to be consistency in our approach to vetting membership applications and this forms a key part of our membership policy so as to reassure current members that their fund is being well protected and preserved. On the other hand MDDUS is not some exclusive club and we recognise that all healthcare professionals deal with risk everyday in their jobs and our role is to offer our broad membership access to support and protection should anything go wrong.

Peter Johnson is risk manager at MDDUS