The ghost of Harold Shipman

Of all the absurdities currently guiding UK government health policy, the notion that an intensive inquiry into the work of Britain’s first GP serial killer provides the basis for a comprehensive reform of medical practice surely takes the biscuit (1). The measures proposed in Dame Janet Smith’s report, published yesterday, are likely to prove more damaging, to both doctors and patients, than the activities of one deranged GP.

Dr Harold Shipman was convicted in January 2000 of killing 15 patients while working as a GP in Hyde, near Manchester. Later investigations suggested he may have killed as many as 215 patients. He committed suicide while in prison in January 2004.

Dame Janet Smith’s 1,300-page report on Shipman accuses doctors in the General Medical Council of ‘looking after their own’, rather than making patients’ interests a priority, and makes 100 recommendations for the reform of the profession’s regulatory procedures. While she admits that, even if all her proposals were implemented, this could not guarantee that another GP serial killer would be detected, she believes that the chances of another Shipman appearing would be much reduced.

Given that Shipman was the first serial killer to appear since the emergence of general practice in the mid-nineteenth century, the chances of any repetition of such bizarre events must be regarded as remote. Yet medical practice is now to be regulated on the assumption that any doctor is a potential mass murderer whose malign intent must be exposed at the earliest opportunity (2).

Because of her focus on Shipman, in her assessment of contemporary medical practice, Dame Janet identifies the wrong problem. The problem is not that serial killers are lurking in GP surgeries; nor is it that most doctors are, like Shipman, arrogant and paternalistic. The real problem is that doctors in recent years have become increasingly diffident and lacking in confidence.

Far from being paternalistic, doctors are reluctant to take responsibility for making clinical decisions, often using the formalities of ‘informed consent’ to pass the burden back to the patient. (3). This is in part attributable to the climate of scepticism about medical science and distrust for the medical profession that has been nurtured by opportunist politicians and cynical intellectuals. It has also been encouraged by the defensive response of the leading figures of the medical establishment who, far from ‘looking after their own’, have made concession after concession, even staging showtrials – such as the GMC Bristol inquiry – in an attempt to appease public prejudices (4).

Dame Janet approves of the trend for increasing lay participation on the GMC, but insists that it must go further, ending the medical majority on its governing body and hence the principle of professional self-regulation. But how does a lay majority protect the public? One of the most memorable moments in the Shipman story was the wave of protests from his patients when he was first suspended from practice. The fact that this mass murderer was, in his own community, a popular and respected GP suggests that patients are not necessarily the best judges of the professional standards of their doctors.

This is confirmed by the long history of charlatans and quacks who appear highly plausible to the public, but not to experienced doctors. The medical profession established the GMC to set a higher standard of practice than could be achieved through the market: a competent doctor had to satisfy his peers, not people without professional expertise. It is true that the statutory authority given to the GMC has contributed to the social and financial success of the medical profession. It has also, despite the periodic appearance of doctors who were corrupt, incompetent or lecherous, and despite too the clubbish ineptitude of its procedures, contributed to the gradual improvement in standards of medical practice.

The problem is not that recent GMC reforms have not gone far enough. The problem is that they have been moving in the wrong direction (5). Instead of surrendering control over the profession to members of the public – who will be appointees of the government and thus not in any sense representative of, or accountable to, the public – we need a medical leadership capable of providing a robust defence of the profession and its expertise.

The real threats to standards of medical practice are not surgery serial killers, or even the minority of idle and incompetent practitioners that has always made up a proportion of the medical profession (as of every occupational group). The real threats come from the intrusion of market forces into professional relationships, from incessant government interference in day-to-day medical practice, from the bureaucratic imposition of forms of third-party regulation that create a great burden for practitioners but provide no benefit to patients.

By chasing the ghost of Harold Shipman, Dame Janet serves neither doctors nor patients.

Dr Michael Fitzpatrick is the author of MMR and Autism: What Parents Need to Know, Routledge, 2004 (buy this book from Amazon (UK) or Amazon (USA)); and The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA).

(1) Shipman report demands GMC reform, BBC News, 9 December 2004

(2) After Shipman, by Dr Michael Fitzpatrick

(3) Hippocratic Oaths, by Raymond Tallis, 2004

(4) Bristol Inquiry: key questions, by Dr Michael Fitzpatrick

(5) Policing the medical profession, by Dr Michael Fitzpatrick