Personal View: Moving on from Shipman
Authors: Vikram Tanna
Journal: BMJ (2005)

Our profession needs to face head on the issues raised in the report of the Shipman inquiry. The main charges against the profession are structural and cultural. The structural and systematic loopholes that allowed Shipman, Ledward, and others to go undetected for years are being addressed by the chief medical officer's review of the General Medical Council and its proposals for revalidation of doctors. What about the “medical culture” that allowed these events to occur? What about the charge of collusion, the charge of a doctors' “club” looking after doctors? What about the culture that frowns on a doctor who questions colleagues or superiors about their practice? How do we change the culture of a profession? I think large parts of our profession are still in a state of denial.


We get frustrated when some doctors talk as though nothing needs to change much


I worked in the same area as Harold Shipman. The doctors in Hyde and Tameside were also in denial to begin with. After the initial shock and disbelief we thought Shipman was a one off, an aberration, an evil murderer, and nothing to do with us. The implication of this denial was that we thought we did not need to change anything.

It was only when we were brought face to face with Shipman's actions that our feelings, and then our behaviour, began to change. All doctors in the Hyde area had countersigned some cremation forms brought by Shipman. When we were interrogated by lawyers representing the relatives at the inquiry and forced to analyse these cremations, some were natural deaths and others were found to be murders. All of us have felt the pain of bereaved relatives, many of whom are our patients, and some relatives are still grieving.

Everyone in Hyde knows somebody in his or her circle of family and friends who was affected by the Shipman tragedy. One of Shipman's victims was the wife of a patient I looked after for 15 years. They were a lovely, decent couple who had worked hard through their lives and asked for little in return. They moved, joining Shipman's list, and he murdered her. Another victim was the wife of a friend of mine. Both husband and wife were Shipman's patients and spoke highly of him. My friend died a natural death, but his widow was later killed by Shipman. How dare he? How could he? And he was “one of us”!

Gradually but inevitably the denial turned into anger, and, much later, the anger into acceptance; but the experience changed our outlook and our culture and drove us to action. The Tameside Local Medical Committee protocol for filling in cremation forms was devised. We now routinely inform relatives of dying patients that if a cremation is required a second doctor will want to phone or meet them to ask questions. We name the carers and relatives involved, including their contact details. When countersigning another doctor's form we routinely ask carers and family of the deceased if they have any concerns.

Our primary care trust, having itself undergone scrutiny and self analysis, now has a robust policy on controlled drugs and a high level performance management group. The trust has drawn up a policy on whistleblowing, which it has recommended all practices to adopt. It allows doctors and other staff to voice concerns regarding a fellow professional's performance or conduct that may be compromising the safety of patients. This does not mean we have lost trust in our colleagues—merely that we are more vigilant, making patients' safety our first concern.

Most doctors provide good care most of the time, but this is not acknowledged or celebrated in a public way. It is not surprising that doctors would feel they are being “criminalised” for the sake of a few high profile cases of rogue doctors. Moreover, we get frustrated when some doctors talk as though nothing needs to change much. Doctors who speak in favour of the Shipman report are often castigated; some dare speak only in private. This is an unhealthy state of affairs. The profession should have an open culture. The response from many of our leaders, with notable exceptions, has been a defensive one. Perhaps they need to feel the pain before they change their attitude. They will be most welcome to visit Hyde and share our pain and the grief of our patients. However, please let us move on from denial towards, yes, anger, and then acceptance and action.