Disappointing news as a breast surgeon is charged with abusing patients. Ian Paterson, of Birmingham, was found guilty of wounding with intent last week. The charges raise questions not only of the doctor’s conduct but of how such behavior was missed for so long. With medicine under the radar, trust in doctors has never been more important. With the doctors ‘good bedside manner’ and the trust’s refusal to investigate complaints both implicated, the course is troubling. Is the Hippocratic Oath Enough?
Mutilating Surgeries on Bogus Diagnoses
Ian’s case is not the first of a doctor abusing care. Ian took advantage of vulnerable patients, abusing a position of trust. His crime, performing mutilating surgeries on the basis of bogus cancer diagnoses. In addition to this, he failed to clear cancer when it was present. With the majority of medical care shared between numerous team members, it is a surprise that issues were not raised earlier. The true story only emerged later.
Paterson was originally investigated between 1997 and 2012. After being forced to leave one trust for suspiciously high cancer recurrence rates, he was eventually suspended by the General Medical Council. Sir Ian Kennedy, a law professor, who investigated the case in 2013, stated that NHS trust where Paterson worked ignored complaints against him because they “preferred good news to true news”.
The reality may have been that they ignored complaints because of his impeccable bedside manner manipulating patients and staff alike to completely trust and believe in him. From a technical point of view, he is also said to have had the knowledge and skills of an excellent surgeon which makes the violations even more chilling. In contrast to this, colleagues have relayed stories of bypassing to avoid confrontation with his bullying character. This ultimately led to him being isolated and able to carry on with his maligned ways. Unfortunately for his patients.
The Hippocratic Oath – A Shield for Abuse?
Every medical student relishes the moment they become a doctor. A position of honor and trust, earned through thousands of hours of hard work. It is, therefore, disappointing to hear that a once respected member of the medical community has taken advantage of their position by defying the oath and abusing their patients for financial gain. Upon graduation, doctors recant the ‘Hippocratic Oath‘, in which we promise to treat our patients to the best of our abilities; maintain their dignity and above all ”do no harm.’ In basic terms, it fulfills four criteria.
- Beneficence- do what is best for patients (treatment must be in best interest)
- Non-Maleficence- do not harm to patients (treatment must not cause overall harm to patients)
- Autonomy-enable patients to have self-rule (make their own decisions about their treatment)
- Justice- equal access to healthcare for all (a founding principle of the NHS)
Cases like Ian’s pose questions; Why did he do this? Could it have been stopped? How do we prevent this in the future? There are no simple answers but often the focus turns to medical students and junior doctors. Measures are put in place to stop the future Ian Paterson from committing these crimes such as revalidation and progression panels. Have such measures stopped Ian Paterson from progressing? As we can see he would have passed with flying colors. He was not picked up until it was too late, he had harmed and violated the Hippocratic Oath. Clearly, some may slip under the radar, with a good bedside manner a shield.
The medical community now faces a big challenge; how does it prevent the progression of future oath breakers? How do we spot the few who abuse?
A note from the Editor – The Hippocratic Oath, Google, and Paternalism
Ian’s case is a rarity, but not isolated. Cases of doctors abusing trust are often sensationalized. The cases of Harold Shipman, Jack Kevorkian and others must be balanced with the overwhelming majority of good care. But the question of how these doctors are able to proceed to abuse patients is a difficult one. The answer it seems is complicated, but is found in ‘trust’. In Ian’s case, as much as in Harolds and Jacks, a combination of trust and lack of knowledge contributed to problems. Patients do not classically understand the complexity of medicine, and emotive subjects blind our rationality even further. We rely on doctors, calm, trustworthy and knowledgeable, to think for us.
In modern medicine this ‘paternalistic’ view of care is outdated. Patients are respected and asked to be informed advocates of their treatment. In each case, patients have clearly explained any health issue and the treatment. We are taught in medical school to follow strict guidelines, but the real reason is honor and respect. To treat a patient is a privilege. Unfortunately, life isn’t so simple, and explaining something to a patient does not mean they will understand it. Patients also lie, not wanting to bother the doctor. Some want to be told what to do. In my experience, this is especially prevalent in older patients, where their life experience of their GP is much more didactic. Questioning a doctor seems to be a virtue of the Google Generation.
In some ways, the Hippocratic Oath is a good thing, and in others a bad. Placing your hand on a bible in court does not mean you won’t lie. Words are only as binding as you decide the to be. The solution it seems is the regulatory oversight, and the impetus on staff and trusts to raise concerns early. Only through a high index of suspicion, regardless of manner, can we spot the bad eggs.
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Sources and Further Reading