Under The Microscope

PROBLEM DOCTORS -- A CONSPIRACY OF SILENCE, edited by Peter Lens and Gerrit van der Wal; IOS Press, 1997; 274 pp; $152.00

Reviewed by Craig Webster

The realisation that doctors are human after all may have been a long time coming -- but is certainly no shock. The strict selection processes and training involved in becoming a doctor do not guarantee that all graduates will be competent for the entire length of their careers. Indeed the stress of the job and the expectation that doctors are some-how superhuman can often exacerbate the normal human frailties that we are all prone to. Doctors take less sick days than other professionals and are less likely to seek counselling; instead some may use alcohol or drugs to help them cope.

This book examines the entire scope of the problem of malfunctioning doctors, including the different kinds of problems they are prone to, their causes, how to spot them and what best to do about them. Its approach is reasoned, not alarmist. The actual percentage of problem doctors is low (estimated at 3%) but high enough to be of concern to the patient and the profession. While the patient is the most visible victim of malpractice, in reality the doctor-patient equation has two sides and comes with many social expectations which are not welcoming of admissions of the doctor's fallibility. To fully understand what causes doctors to become unreliable and to deny their ill health or drinking problem requires more than just sanctions when something goes wrong.

Although it is clear that English is not the first language of the authors of some chapters, this book is well written and topical. Currently in the US and Britain the issue of dangerous doctors has a very high profile, as both governments work hard to find more effective ways of dealing with the problem. Perspectives from many countries are presented in this book, as is data from large-scale ethnographic studies on the incidence and nature of problem doctors. Many mini case-histories are presented throughout which effectively anchor the theoretical discussion in reality. The authors conclude that better detection of problems through national monitoring schemes and specific on-going education on all aspects of performance are likely to be the most successful approaches in reducing rates of malpractice.

Craig Webster is currently a clinical researcher in the Anaesthetics Department at Auckland's Green Lane Hospital.