Leading Article: Arrogance has no place in the modern medical profession

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The Independent Culture
DAVID SOUTHALL, a consultant paediatrician at the North Staffordshire Hospital Trust, carried out a clinical research project for a new type of ventilator. The exercise involved 122 premature babies, and 43 of them died or were injured. It seems a high mortality rate, although these were sick babies and at this stage we do not know the precise details of what happened. The truth will not come out until the publication of the report of the official inquiry that, The Independent reveals today, has been ordered by the Government. What is clear, however, is that the allegations against Professor Southall being made by the parents of the dead and injured babies are extremely serious. If well-founded, they would be the latest in a succession of episodes that have begun to fracture the public's implicit faith in the medical profession.

Few branches of care are more emotively charged than the treatment of sick, fragile and vulnerable infants. And even in this most sensitive of areas, ethical carelessness has crept into the behaviour of some doctors. The most notorious recent case was that of the Bristol heart surgeon James Wisheart, who was found guilty of serious professional misconduct when 29 out of 53 infants in the care of his team died. But similar standards appear to have seeped into other areas of medicine; thus, last November, we learnt about the incompetence of Rodney Ledward, who obscenely boasted that he was "the fastest gynaecologist in the South-east".

The likes of Wisheart and Ledward are isolated examples. But it takes only a few cases of corruption or incompetence or unethical behaviour to taint a whole profession - just ask any politician or journalist. Medicine's governing bodies have to be extremely alert to protect the reputation of those dedicated, skilled and caring figures who make up the bulk of the profession.

But this cluster of cases does also give rise to another worry: namely, that there is a touch too much arrogance within the profession. At the heart of all these scandals is a disregard for adequate consultation with patients, or patients' relatives, a problem all too familiar with those who have regular dealings with the medical profession. In today's consumer- led society, the idea that Doctor knows best is as outdated as the concept of the curative power of bleeding a patient. This is something that needs to be learnt by all doctors.

The answer lies in more openness. According to the parents in the Southall case, they feel angry that the nature of the treatment their children was to receive was not fully explained. The full implications of any treatment should be spelt out to patients or their guardians, especially in cases of extreme distress. Only in this way can new treatments be legitimately tried.

Could it also be that we have been attracting the wrong types into the medical profession? The best doctors are not just brainboxes, but those who can empathise with their patients. This emphasis on a good bedside manner is something which medical training is only now starting to take into account again.

Openness applies to the community as a whole as well as to individual patients. The arguments for publishing performance tables for trusts, hospitals and, indeed, doctors are overwhelming. It is something that is fiercely resisted. It is true that such statistics are open to misinterpretation. But they can also, when used with care and proper adjustment, identify poor performance and shed light on abuse.

We do not lightly criticise the medical profession. Most of us are still happy to trust our doctors. But this state of affairs will continue only if the profession embraces a sort of medical glasnost. Openness could turn out to be the most valuable clinical experiment of all.