COMMENT:MD: A LICENCE FOR LIFE

We have now reached the point where, on balance, well meaning doctors in general practice and highly trained, well equipped specialists working in hospitals do more harm than good. Through a mixture of ignorance and incompetence doctors are killing

Dr Gareth Beevers, a physician at the Dudley Road Hospital in Birmingham and a lecturer in medicine at Birmingham University, estimates that around one in eight patients in hospital are there because of problems caused by drugs their doctors prescribed.

Writing in the Postgraduate Medical Journal two pathologists reported than after carrying out 400 post mortem examinations they found that in more than half the patients the wrong diagnosis had been made.

A study of GPs reported in a medical newspaper showed that a quarter of general practitioners do not know about the connection between smoking and heart disease, while, amazingly, 20 per cent of GPs are unaware that cigarettes can cause lung cancer.

Dr Badal Pal, senior registrar in the Department of Rheumatology at Dryburn Hospital, Durham, questioned 70 general practitioners and found that half of them knew little about the ingredients of popular non steroidal anti inflammatory drugs probably the most commonly used drugs today.

A survey conducted by the Royal College of General Practitioners showed that many experienced family doctors had inadequate knowledge about the diagnosis and treatment of common disorders. Questionnaires which were posted to 1,400 general practitioners included questions about common conditions such as anaemia, middle ear infection, glandular fever and jaundice, but according to Dr William Acheson, senior lecturer in General Practice at Manchester University, many of the doctors who responded left out important information or “gave answers that were clearly wrong.” Only half the doctors in the survey mentioned the three most common symptoms in middle ear infections. More than half left out important questions to ask a patient with jaundice.

But it is not only family doctors who need to be better trained. A report published in the Journal of the Royal Society of Medicine concluded that many hospital patients who suffer heart attacks die during the “confused and disorganized charades” of attempts to save them because hospital doctors do not know how to give emergency resuscitation. According to the report, which surveyed 50 junior hospital doctors, only four doctors were able to perform effectively when asked to demonstrate their skills on a model.

The little that doctors do learn about new treatments comes from the companies promoting their products. Even Dr Patrick Pietroni of St Mary’s Hospital Medical School, who helps to educate doctors, admits that “over 40 per cent of the information which influences their decisions as to what to prescribe is received by them directly from drug companies”. We need to encourage doctors to take a more cynical and sceptical look at the claims made by the big drug companies.

We also need to introduce annual tests for doctors. Airline pilots have to undergo regular tests. We should not allow surgeons into the operating theatre unless they have made some effort to keep up to date.

Doctors have a tremendous position of power and can probably do more harm than any other group of individuals in the community. But once a man or woman receives a degree certificate he or she is given a licence for life. Who would willingly fly in a plane piloted by a man who had passed his exam 50 years earlier and had not made any attempt to keep up to date?

Author and medical columnist Dr Vernon Coleman now edits a quarterly medical journal, which is available by sending £10 to European Medical Journal, Lynmouth, Devon EX35 6EE.