Chairwoman of Shipman inquiry protests at lack of action
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7550.1111 (Published 11 May 2006) Cite this as: BMJ 2006;332:1111
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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
Competing interests: No competing interests
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
Competing interests: No competing interests
Shipman - Let's get realistic
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
Competing interests: No competing interests