We trust our medics, don't we?

by Watchman

Doctor and patientA good relationship between a GP and his or her patient relies essentially on trust; and the recent ruling by the General Medical Council to apply a (mere?) six-month suspension to Glasgow GP Dr. Iain Kerr carried the comment that his action in apparently assisting her suicide was 'inappropriate, irresponsible, liable to bring the profession into disrepute and not in [his] patient's best interest'.

However, hospitalisation is increasingly being perceived as a possible hazard to health in the light of reports which suggest our hospitals are awash with life-threatening infections such as MRSA and Clostridium difficile. [The latter has just been named in an official report by the Health Commission as a cause of, or factor in the deaths of 331 patients in a Kent hospital which has reportedly suffered ‘appalling standards of care, crowded wards, financial problems, a shortage of nurses and poor hygiene’.]
Accordingly post-mortems are increasingly coming into focus as there can be no guarantees following the death of a hospital patient that their initial ailment (which may indeed be relatively minor, easily treated and not normally life-threatening) was the cause of their demise.

But there may be other problems lurking in our hospitals.

Hospital WardSome considerable time ago an elderly lady in a Highland hospital was observed by a visitor as being unconscious and connected to a drip. She ultimately died, but the fact that the bag which should have contained the fluid was observed to be empty, gave cause to wonder whether any ‘no intervention’ instruction that might have been in force was also being applied to the maintenance of adequate hydration levels.

“Water just passes right through him.”

Some years later a pastor working in Scotland reported an incident which occured during a visit to a terminally-ill parishioner in a local hospice, whereby the dying man grabbed the pastor’s hand and attempted to suck moisture from the latter's finger. Alarmed by his friend's actions, the pastor alerted the medical staff to the fact that their patient was dehydrated; perhaps to the point of delirium. The indifferent reply he received with respect to the patient was: “Water just passes right through him.”
The patient died very shortly afterwards: who knows but dehydration may have hastened the process?

So maybe autopsies are becoming a necessary routine in terms of checks and balances in the healthcare system.

But what has all this to do with Dr. Iain Kerr and his patient? Well, Dr. Kerr is a general practitioner, and so was Dr. Harold Shipman. And before he was caught, the latter was reported to have killed between 215 and 260 people over a 23-year period in his Greater Manchester practice.

Now while there is absolutely no similarity between the circumstances of  Kerr and Shipman, both these situations raise the question of the essential trust that there needs to be between physician and patient. And if this trust is lacking, or even diminished, then the patients' fears, and the inevitable and negative consequences for the delivery and oversight of medical services are not difficult to imagine.

The Hippocratic Oath affirms:

“I will give no deadly medicine to any one if asked, nor suggest any such counsel…”

Dr Iain KerrFrom a lay person’s viewpoint it would seem that Dr. Kerr was, and is guilty of a direct contravening of that pledge taken by medical practitioners over the last 2,400 years. And an oath that has stood for that length of time is surely worthy of respect?
[ It is perhaps worth noting that the next part of the sentence continues: “… and in like manner I will not give to a woman a pessary to produce abortion.” Mmm…. ]
Dr. Iain Kerr

It is pertinent then to consider whether the (some-may-say 'lenient') judgement passed by Dr. Kerr’s professional body gives out a rather soft, even ambiguous signal regarding how the profession in general, and the GMC as a governing body view his actions.

So it is a great pity that Dr. Kerr’s ‘treatment’ of his patient and the GMC’s judgement of his conduct serve to undermine the trust and respect which the vast majority of family doctors and other medical professionals enjoy and deserve.

But it is an even greater pity that because of these things the general public can no longer guarantee that the healthcare which they have traditionally received and come to respect, before and since the advent of the National Health Service, is delivered in a manner which will be consistently and entirely beneficial to their continued well-being.

In the light of the most recent GMC judgement, post-mortems might, perhaps should, become a growth industry. If this is so it will be very sad indeed.

Given that the vast majority of medical professionals are conscientious, and abide by the ethical guidelines surrounding the provision of health care it will be a great pity if this present case, or any other, serves to undermine the confidence and respect that we have in and for those who look after physical and mental well-being.

We do need to be able to trust our medics, don't we?


Some Quotes:

"A doctor who provided tablets to help a patient end her own life could return to work in six months time, prompting fears that regulators are softening their line on euthanasia."
Christian Institute

"Doctors wield real power and those with pro-euthanasia agendas can abuse that power."

“We are frequently presented with demographic research which talks in terms of the ‘problem’ of the increasing number of elderly people in society. This is frequently described as a ‘burden’ on the health service. Caring for them is costly.

It is only a short jump to applying that same language to individuals. A costly burden and a problem to be solved.”


Ed footnote:
Much of the argument around the medical ethics of euthanasia is to do with 'intent'.
If the (doctor's) intention is to relieve suffering then medical intervention is permissible, adviseable and desirable. However if the intention is to accelerate the death of a patient then such action is - - under present rules - unethical, even illegal.
And the question then arises: "Who can claim to read a medic's mind?" And how would all this stand in a court of law?

See also: Christian Medical Fellowship and  Nurses Christian Fellowship of Scotland

Watchman, 30/07/2008