Involving community may be way forward post-Shipman

doi:10.1136/bmj.326.7397.1038

BMJ 2003;326:1038 ( 10 May )

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Involving community may be way forward post-Shipman

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EDITOR $---$ Baker et al monitored mortality in general practice after Shipman.¹ A statistical monitoring process with high enoughsensitivity to detect murder would almost certainly give manyfalse positive signals. This could cause severe damage both topractitioners and to their relationships with theirpatients.

A statistical monitoring process with high enough specificity to avoid false positive signals may take so long to signal thatmany preventable deaths could occur. A practitioner bent on deliberatemurder would almost certainly be expert at gaming any such monitoringprocess. Requiring groups of practitioners to review the deathsin their practices at regular intervals with a view to improvingthe quality of patient care is an excellent idea, but it is difficultto see how this would deter amurderer.

It is essential for dealing with substandard performance that the underlying system is first analysed carefully and fixed.Judgmental monitoring without that . . . [Full text of this article]

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Monitoring mortality rates in general practice after Shipman: Richard Baker, David R Jones, and Peter Goldblatt
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