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Rapid Responses: Rapid Responses published:
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It's not that easy
- William E. Osmun (14 May 2006)
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Unrestricted Discretion of Dame Janet?
- Jay Ilangaratne (18 May 2006)
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Dame Janet's disappointment
- Gerald Freshwater (18 May 2006)
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William E. Osmun, Family Doctor Mount Brydges, ON, CA, N0L 1W0
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Firstly, can we put Harold Shipman aside. What he did was horrible, but basing a system of re-validation on the actions of a psychopathic mass murderer is absurd. No matter what system is put in place it will not stop the psychopath, just as all the fences in the world will not stop a suicide bomber. The whole problem with keeping an eye on one another is no one knows what we are keeping an eye on. What is a 'good enough' doctor? We can all enumerate the qualties of a 'good' doctor - compassion, knowledgeable, clinical skills, dependable with a healthy dose of common sense for starters. But can we define the doctor that needs to be 'struck off'? That is a whole different story. Sadly, and I am not surprised Dame Janet doesn't get this as I suspect she inhabits the black and white world of the law courts, medicine is rarely black and white but a confusing number of shades of gray. For example, if a diabetic patient has a blood pressure of 140/80 am I a bad doctor, a good enough doctor or a good doctor. What if said patient's other indices are spot on? What if the bp is a lovely 120/80 but she feels terrible and only stays on her pills because I insist? What if the Bp is 160/90, 200/100? I could go on. I teach and struggle with just such dilemmas all the time. When should a student or resident be failed? Do I fail them for always being late? Do I fail them because they show up but don't seem particularly interested? Do I fail them because their clinical knowledge appears to be a bit less than their peers? I don't know. If anyone else does, I would love to hear from them. Competing interests: I'm a doctor. |
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Jay Ilangaratne, Founder Medical-Journals.com
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A wider debate should ensue whether it is proper now for Dame Janet to revisit the Shipman Inquiry which she had to conduct under a strict remit. The remit given to Dame Janet by the Government in relation to Shipman, did not include a follow-up of her own recommendations particularly at a doctors' forum. Dame Janet's such post-event comments are akin to a Judge's analysis of her own original judgment given in a court of law. Or is it that Chairs of public inquiries have an unrestricted discretion to comment about their own formal decisions/recommendations whenever and wherever they choose? Competing interests: None declared |
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Gerald Freshwater, Occupational Physician Hill House, Lerwick, Shetland, ZE1 0EL
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The Shipman case is hardly relevant to the regulation of the medical profession, since it is the job of the police to detect murder. It has been chosen, however, as a convenient stick with which to beat us. After all, the DVLA was not restructured when the 'Yorkshire Ripper' was found to be a lorry driver, although his occupation allowed him to travel around the country murdering women. The tone of Dame Janet Smith's opening remark furthers the damage to our profession; why should patients not have faith in doctors? It is valuable to them when being treated, especially as the doctor is often part of the treatment. It is also helpful to the doctor, since to present the patient with a clear and balanced account of every factor considered in the choice of treatment is usually impractical. When revalidation is finally implemented, I expect very few patients will check their doctor's score, but will continue to trust the doctor as usual. More worrying is the expectation that her recommendations would be acted upon promptly and without further review, testing or modification, and that this expectation is shared by influential academics such as Professor Elwyn. Whilst Dame Janet was used to dealing with medical mishaps in the course of her legal practice, this is not necessarily the best grounding in managing the regulation of the generally competent majority of practitioners. I do not believe that regulatory affairs in the legal profession are so much further ahead as to be a source of expertise, either. The lack of wide consensus shows that the design and implementation of a fair and effective regulatory system is not a simple matter; the General Medical Council has had this as its chief remit for more thena century, and if it were easy, they would have had something in place which would have weathered the Shipman storm, although probably not prevented it. Certainly the GMC must develop its system of regulation to meet reasonable contemporary expectation, now and in the future. However, to base this on a single case is as inappropriate as promoting a new treatment after one success, and we should be properly critical of unproven innovation. Competing interests: Registered with the General Medical Council |
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