BMJ  2006;333:970 (4 November), doi:10.1136/bmj.333.7575.970-a

Letter

The BMJ interview: Sir Liam Donaldson

Avoiding the painful truth and scapegoats

EDITOR—I write with reference to the BMJ interview with the chief medical officer, Sir Liam Donaldson.¹ I do not support his proposal that the standard of proof should be the civil standard when adjudicating about a doctor's performance.²

Credit: MARK THOMAS

 

The individual doctor is the natural target when things go wrong and someone is needed to carry the blame, but this is scapegoating. When this occurs other, more abstract, institutional factors are missed.

When facing illness, disability, pain, blighted lives, and death many patients, families, and professionals invest medicine and doctors with a supernatural power to overcome illness. But these fantasies cannot be sustained when reality reveals the truth that doctors are limited and that some are more limited than others; the disappointment that follows can create a wish for revenge.

The revalidation agenda is politically expedient. The reality of rationing cannot be denied. However, the political debate we have avoids acknowledging the reality of the fragility of human health, limited public resources, and the limited power of medicine to "make things right."

Instead the government and the chief medical officer have encouraged fantasy thinking by promising ever better care, and ever higher standards, more nurses, more doctors, more operations, etc. The consequence is that someone or something has to carry the badness, and this seems to be the "underperforming doctor." The revalidation debate risks colluding with this manic response and makes the scapegoating of individual doctors more likely.

As doctors we should lead the way in pointing out the painful truths of human existence, sickness and death, the limitations of medicine, and acknowledge explicitly the limitations of funding that occur in any health system. The criminal threshold should be retained for actions that threaten the livelihood of the doctor under investigation. If this threshold were to be lowered to the civil level then, on the balance of probabilities, many doctors may find their lives wrecked as they become scapegoats of a system in denial.

Cassel Hospital, West London Mental Health Trust, Richmond TW10 7JF Daniel.McQueen{at}wlmht.nhs.uk

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Competing interests: None declared.

References

1. The BMJ interview: Sir Liam Donaldson. http://bmj.bmjjournals.com/cgi/content/full/333/7573/DC1 (accessed 26 Oct 2006).
2. Good doctors, safer patients: Proposals to strengthen the system to assure and improve the performance of doctors and to protect the safety of patients. London: Department of Health, 2006.

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