Doctors mangled by “justice”

This morning I spent three hours in the chambers of a Queen's Counsel. It was like a stage set. The open fire crackled. The view over the 18th century lawns was magnificent. The room was lined with leather bound reports from the appeal courts of the 1890s. It was impossible not to be impressed by the forensic precision of the lawyers' minds, and we all had a lovely time. But many doctors' experiences of the law are nothing like this Georgian arcadia but rather a brutal mangling. I've read of two such cases this week.

The first was in JAMA and described the case of a family physician in an American academic centre who saw a 53 year old man for the “routine physical” that is common in the United States but uncommon in Britain (2004;291: 15-6). The physician and patient discussed the possibility of measuring the man's prostate specific antigen. The easy thing would have been to simply order the test. Instead, the physician opted for the modern model of patient partnership. He explained the pluses and minuses of the test, and the fully informed patient decided against. Three years later the physician was sued because the patient had developed metastatic prostate cancer and died. The physician was exonerated, but his academic programme is liable for a million dollars.

This story is likely to strike terror into many doctors. “This could easily have happened to me,” might be the first thought. “It's so unjust” might be a second: “The doctor goes to all this trouble, practising medicine in the way we teach now—and still gets screwed.” Then there are the implications for practice across the United States. Many patients—often prompted by the media—are asking to have their prostate specific antigen measured. Will doctors discuss with them the risks and benefits of the procedure—or will they simply suggest that the patient has the test?

The “villain” in my second story is less the law and more the media. The Daily Mail last week carried the headline “The killer doctor back working in hospital” with a picture of the doctor (7 January, p 5). The doctor had been found guilty of manslaughter for failing to diagnose a knee infection that complicated surgery and led to the death of a young man. “He escaped a jail term after his barrister pleaded that his career was in ruins,” reports the newspaper; and he was not struck off by the General Medical Council.

The doctor has now been re-employed in a training position, greatly upsetting the father of the young man who died. “I don't think,” says the father, “there is any normal human being in this country who would say this is right.” To suggest that anybody who thought it was right—including the courts, the GMC, and the employing authorities—are not “normal human being[s]” may be strong, but it's understandable and excusable in a bereaved father. What is inexcusable is to report the story in a national newspaper.

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