Posted By Graham Bullough
Jayne - I don't work in the healthcare sector so I've no access to policies of the sort you describe. Such policies probably exist - as documents produced nationally by the NHS, BMA, etc. and locally by healthcare trusts. However, it is likely that there are problems in agreeing standards about what is acceptable and what is poor performance. If such standards exist, are statistics about performance obtained, compiled and made available, and to whom? Ultimately, it is likely that only doctors can assess and judge the performance of doctors, and doctors tend to be loath to publicly criticise or condemn fellow doctors. Phil Hammond (with whom I have no connection) includes this theme in his commendable book "Trust me I'm a doctor", and expands on the Bristol paediatric heart surgery saga as an example.
The Shipman case also provides a classic illustration of the reluctance of doctors, and everybody else, to question or take effective action regarding suspect doctors. Local undertakers noticed that the death rate of his patients was higher than average, as did a GP in a neighbouring practice. Initially she found it difficult to believe what she suspected he was doing, but took the plunge to go to the police about it. However, the police investigation was inconclusive, possibly because, among other things, the investigators found it difficult to suspect or effectively challenge Shipman because of his exalted position as a doctor. Nevertheless, knowledge of this investigation no doubt helped to strengthen the later investigation which stemmed from the complaint about Shipman after he forged the will of one of his victims.
As a young GP Shipman was convicted on related several counts for abusing drugs - apparently after being reported by the senior partners of the practice for which he worked. However, it seems that subsequently he got no more than a reprimand from the General Medical Council. Apparently no action was considered either to stop him from continuing as a doctor elsewhere or at least to monitor him wherever he worked. In his book Hammond relates that confidential studies showed that a significant number of UK doctors have problems with alcoholism or abuse of drugs - which inevitably impinges on their performance and the safety of patients.
As well as mentioning a potential snag with policies regarding poorly performing doctors, another aspect of this response is the need for a change in attitudes so that fewer people regard doctors as infallible super-human people. Doctors are ordinary humans with specialised training for their work, a lot of power and responsibility and tend to have heavy workloads which are subject to increasing demands and pressures. Like other humans, they often work excessive hours, get tired, make mistakes and are vulnerable to stress, etc. Thus, as with other occupations, there should be proactive arrangements and procedures, etc., to enable doctors to work efficiently and with minimum risk to patients, themselves and others - as well as reactive measures to detect when doctors and arrangements are lapsing.