Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Shipman inquiry - lack of action
- gordon pledger (13 May 2006)
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Dame Janet's indignation helps no-one
- peter mahaffey (18 May 2006)
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Shipman - Let's get realistic
- Charles A. West (25 July 2006)
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gordon pledger, medical referee Newcastle upon Tyne
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I have been a medical referee for 19 years, and gave evidence to both the Shipman and Home Office inquiries. Changing the coroner system requires legislation and lengthy implementation. Improving professional governance requires sensitive handling if it is to be effective without demotivating and stultifying professionals. However the ineffective and costly certification procedures could be improved by regulation rather than legislation. Better death certificates, abandoning the present cremation forms, the establishment of "medical examiners",random audit of deaths, and closer links with local clinical audit systems could be achieved fairly soon. It would be interesting to know if the relevant Government Departments are ready to undertake pilot studies, as there are many minor practical details that will need sorting out, not least with funeral directors, to enable a smooth move to a better system. Competing interests: None declared |
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peter mahaffey, consultant surgeon bedford hospital
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Dame Janet Smith's barbed statement (BMJ 13th May, p1111) "Good riddance to blind faith in doctors" is ironic, indeed some might say based on a degree of envy, bearing in mind that her profession languishes firmly at the bottom of the pile in terms of public respect and confidence, a position confirmed year after year in public surveys, whilst ours remains at the top. These are opinions which the law and medicine have respectively earned after years of toil. Yes, there are serious questions of self regulation to address, and I personally found it shocking that none of Dr Shipman's colleagues seemed in a position to question his professional activities even when we are told that his reputation was such that others around jested that to see him as an elderly person might have fatal consequences. But has it occurred to Dame Janet Smith that the reasons her proposals might be so slow to implement are because they are not an appropriate solution? Of the changes introduced, most doctors know that appraisal is in practice both costly and ineffectual and that revalidation is likely to be a more grandiose version of the same. When, one wonders, would a High Court judge be happy to have a doctor sit in judgment of some of the very necessary reforms of HER profession? Competing interests: None declared |
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Charles A. West, General Practitioner Shropshire. SY6 7AB
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Editor, I have been waiting and waiting for someone else to say this. Responses to Shipman have varied from denial on the one hand to the grandiose and unrealistic on the other. There are those who have argued in your columns and elsewhere that Harold Shipman was a psychopath who only happened to be a doctor, and that it is no more logical to introduce tighter controls on doctors than it would be to introduce annual tests for all truck drivers or revalidation for all builders because other mass murderers have been truck drivers or builders. At the other extreme there are those like Janet Smith who would introduce yet more cumbersome appraisal, revalidation and regulation for doctors despite the fact that Harold Shipman would almost certainly have passed all his revalidation checks. There are also those who have advocated that every death in the country should be certified by two independent doctors. What we seem to be overlooking is that Harold Shipman had a history. In 1975 he was found guilty of forging prescriptions for Pethidine which he was using himself. If we accept that addictive behaviour must always have a risk of relapse, it would seem to me to be a sensible precaution that all doctors who are found guilty of a crime involving the use of controlled drugs, should have their prescribing and purchasing of controlled drugs monitored for life. This would be a much more manageable task than introducing a whole new structure for checking every doctor in the land, or duplicating every death certificate. We already have mechanisms for monitoring drug prescribing through the Prescription Pricing Authority (PPA), and the drug squad of local police forces have the authority to check the Drugs register of any GP. The GMC has knowledge of doctors up to date addresses and of criminal charges brought against doctors. It should be quite straight forward for the GMC to initiate a life-time monitoring instruction. It simply remains to decide whether it is the PCT, the Health Authority , or some other body that manages it. Yours, Charles West General Practitioner, Church Stretton, Shropshire. Competing interests: None declared |
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