Pity the poor consultants. No sooner do they recover from the battering given to them by the media over their inability to diagnose cancer of the tongue in a 41 year old man (20 May, p 1414) than they receive a new thrashing over the inquiry into disgraced surgeon Rodney Ledward, who botched operations on scores of women. “The gods who fell and betrayed our trust in medicine” was how the Mail on Sunday described the consultant body after the report was published. “Ledward is an Establishment figure . . . whose disgraceful behaviour was allowed to continue . . . in the full knowledge of powerful figures in the profession. The case destroys the image of doctors as a totally respected elite whose judgement is beyond question,” Peter Dobbie wrote in that paper.
Never slow to take advantage of a passing bandwagon, the politicians soon weighed in against the profession. They saw it as a chance to attack the “toffs” in medicine and stoke up the class war that had been ignited by Gordon Brown's attack on the elitism of Oxford dons the previous week (10 June, p 1612). Alan Milburn went on to the Frost Programme on the Sunday after publication to call for an end to the elitist culture of the NHS in which the “consultant is king.” His attack on senior doctors led to a spate of aggressive headlines the next day proclaiming that “Consultants must answer to patients” (Daily Telegraph) and “ ‘Consultant is king’ culture must end” (Guardian).
Knowing that such attacks were bound to follow the Ledward debacle, the BMA had geared itself up for a counterattack. It took off its gloves and entered the fray. In the four days after the publication of the report, BMA leaders gave 17 radio interviews and five television interviews, submitted at least two articles to the national press (BMA secretary Mac Armstrong's was published in the Guardian), and fired off numerous letters to national and regional newspapers. The association's press office held a press conference on the day of the Ledward inquiry's publication (1 June) and issued two press statements the next Monday.
The counteroffensive paid off. The headlines on Tuesday 6 June were far more sympathetic to the profession. “Doctors refuse to accept blame for NHS failings” declared the Daily Telegraph, while the Daily Mail proclaimed: “Labour ‘insults and assaults’ outrage doctors.”
Swiftly the government's attitude changed. From playing “nasty cop,” a role that seems to come naturally to him, Milburn switched to “nice cop.” He told the BBC World at One interviewer Nick Clarke that “the overwhelming majority of consultants do a quite brilliant job for the NHS” and that doctors did a “very, very good job indeed for the health service.” The government tone did not change even after Ledward came onto Radio 4's Today programme to claim that in striking him off the medical register, “the profession has got rid of a first class consultant.”
Such words do not come easily to someone of Milburn's ilk. He was described by Simon Hoggart in the Guardian as a man who used every oath in the language, except the Hippocratic oath, and as having “metaphorical tattoos all over his political credentials.” When Milburn starts taking an emollient line it must be significant. So are the doctors now in the government's good books, and is it all going to be plain sailing?
Unlikely. A new case is already hitting the headlines (consultant gynaecologist Richard Neale is appearing before the General Medical Council charged with substandard treatment and falsification of documents), and that case will undoubtedly be followed by others. The public will be indignant, and politicians will feel obliged to recognise the public anger and promise to do something. The BMA will have to go on firefighting.
So what is the solution? Strangely enough, the solution that is staring consultants in the face is one that they have just rejected. The GMC's plans for revalidation, whereby doctors will be assessed on their suitability to practise every five years, is designed to reduce the number of Ledwards who hit the headlines. Yet the consultants rejected the GMC's proposals at their annual conference earlier this month (10 June, p 1557). If they do not want to be constantly attacked for the poor performance of some of their colleagues, they had better work out an alternative solution pretty quickly.
Figure.
Another dose of doctor battering