http://www.independent.co.uk/story.jsp?story=52798

 

Grim revelations undermine trust in doctors

By Jeremy Laurance

27 January 2001

This would be a grim year for doctors, the chairman of the British Medical Association, Ian Bogle, warned in his speech to the BMA's annual conference last June. Even he cannot have suspected how grim.

Each week brings more revelations of medical malpractice, failings in the NHS or unprofessional conduct.

This week a GP was convicted by the General Medical Council after failing to spot a tumour the size of a football in the stomach of a nine-year-old girl. Dr Krishna Mohan Singh had dismissed the anxious inquiries of the girl's mother, telling her not to be paranoid. He was allowed to continue practising but ordered to have retraining.

There was also news that a consultant breast surgeon, Briony Ackroyd, had been suspended at Walsgrave hospital, Coventry over concerns about poor practice. She is one of 240 consultants reportedly suspended at hospitals around the country. Ms Ackroyd was a specialist in the "tram-flap" operation in which the breast is reconstructed at the same time as a mastectomy for breast cancer is performed. A dossier of 30 cases was reported to have been sent to the General Medical Council and the hospital said it was reviewing all her work since 1995.

Earlier this month, the scale of Harold Shipman's crimes was revealed by an investigation that suggested he may have killed up to 287 people.

This week a GP in Leeds was arrested and released on police bail over allegations about the disappearance of stocks of diamorphine (heroin) from the surgery and the deaths of elderly patients.

The tide of adverse stories is putting the medical profession under unprecedented pressure. Morale is said to be "terrifyingly low".

Although surveys consistently show patients trust and remain satisfied with their doctors, public trust in and satisfaction with medical institutions is plummeting. The scare over MMR vaccine and the reluctance of parents to accept reassurance about its safety from the Medicines Control Agency, the Committee on Safety of Medicines and a dozen medical organisations is evidence of that.

Next week, the publication of the inquiry into the organ retention scandal at Alder Hey hospital, Liverpool will again see doctors cast as arrogant, remote and insensitive to the needs of their patients. In part, this is unfair. The welter of criticism raining down on the profession is partly generated by its efforts to root out the bad apples. The General Medical Council has tripled the number of disciplinary hearings to clear the backlog of cases - but this means more doctors appear to be acting unprofessionally and being struck off. It is also unfair to tar an entire profession with the brush of half a dozen miscreants, even if that half dozen has become a dozen or even two. Nearly all doctors are conscientious, hard working and driven by a desire to improve the lives of their patients.

None the less, old attitudes die hard, and stories of surgeons who like to boast to their patients "only two people can help you today and God's busy" are still commonplace.

The problem was captured in a speech two weeks ago by Sir Donald Irvine, president of the General Medical Council, who warned that doctors must reform the secretive, paternalistic culture in which they worked. "The cultural flaws in the medical profession show up as excessive paternalism, lack of respect for patients and their right to make decisions about their care, secrecy and complacency about poor practice. These all contribute to a picture which leads the public to believe that a lot of doctors put their interests before their patients'," Sir Donald said.

His audience at the Royal Society of Medicine did not welcome his analysis and the BMA said the picture he painted was not one it recognised. But it is certainly one the public recognises. The loss of deference to those in authority is one of the biggest social changes of the past decade.

But some doctors have still to adjust to the new order.

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