Doctor as murderer

Death certification needs tightening up, but it still might not have stopped Shipman

News p 331

Harold Shipman, a general practitioner from Greater Manchester, has been convicted of murdering 15 of his patients. Inevitably, his conviction raises serious concerns for clinicians, patients, and society. How could such crimes go undetected? What lessons can be learnt and can similar murders by doctors be prevented in future?

Serial killers in health care like Shipman and Beverly Allitt are particularly shocking because they damage the trust that exists between clinicians and their patients. In 1993 Allitt, a nurse working on a paediatric ward, was convicted of murdering four children, attempting to murder three, and causing grievous bodily harm to six.1

Like many singlehanded doctors, Harold Shipman had over 3000 patients in his care. His patients seemed to like him. Until the suspicions began to gather that eventually led to his prosecution, few concerns were raised about his clinical competence. Evidence emerged that he had falsified the notes of some of his patients, but this was not incompetent record keeping: rather, it was done to conceal his crimes.

In 1976 Shipman was convicted of several offences relating to the misuse of pethidine, and this conviction was reported to the General Medical Council. Shipman sought treatment and no further action was taken. This conviction adds to all the other concerns raised, although no evidence of recent drug misuse has been presented. Moroever, it important not to appear to conclude that drug misusers turn into serial killers. Since the 1970s new procedures have …