Perceptions of doctors and what they do

Mostly patients trust doctors. They also trust the tests that doctors undertake, imagining that they will give clear answers. Patients are thus likely to be shocked when they are told that a test that said they did not have cancer was wrong. R P Symonds describes such an episode from the doctor's point of view.

The pathologists in Leicester decided to audit the cervical smear history of 403 women who developed cervical cancer. They discovered that 20% had never had a smear—raising, in passing, questions about equity and screening (p 815)—and that 84 had been given a false negative result and 38 had had their smears undergraded. Twenty of the 122 patients died, and in 14 cases diagnostic delay was a factor. Sixty four patients had treatment that was more radical than necessary. These results are not uniquely bad. Leicester seems to be as good as most other places.

The results were made public, patients were informed, and Symonds and others were left to pick up the pieces—with little preparation. Some patients and relatives were calm, but about a quarter were angry. “Some shouted, and relatives especially tended to blame the messenger,” says Symonds. He discusses the lessons he has learnt from the episode—one is that “perhaps the test has been oversold. Any screening test that relies on visual interpretation of a few abnormal cells against a background of many thousands of normal cells can never be 100% accurate.” Precisely. Doctors should spell out the difficulties of much of what they do, although it might be that testing for human papillomavirus infection would be much more effective (p 772).

If they did so, what would happen to their media image? Most doctors—in Britain at least—feel that stories about them are negative and becoming more so. An analysis of stories about doctors in three national newspapers between 1980 and 2000 (p 782) shows that negative stories are two to three times commoner than positive ones—but that the ratio of negative to positive stories is not increasing. So the perception of many doctors that the media have turned against them is wrong.

As both Chris Martyn (p 814) and Hugh Baron (p 787) remind us, doctors are still the most trusted group in Britain. But are they the most esteemed? Sir Cecil Wakeley Bt KBE CB FRSE FRCS HonFRCSE FFR FRCSI FRACS LlD Dsc insisted to Baron long ago that they no longer were—because the number of honours they received was falling. When he was president of the Royal College of Surgeons in 1949-54 Wakeley would tell the prime minister: “We'd like a peerage for him, a baronet, Ks for this half dozen, and then some CBEs and OBEs.” Now, observes, Baron, only one of 25 new knights is likely to be a doctor.