By Gurli Bagnall, 5 June 2001

Response published in the BMJ Journal

The subject of unhappiness amongst doctors has triggered some interesting responses, but doesn't it boil down to accountability? Instead of complaining about adverse media reports, a fractious public and meddling politicians, the profession would be better employed putting its own house in order.

One place to start would be the common attitude regarding a patient's rights to his records. It is generally accepted that records of treatments and test results should be available, but many object to parting with what they refer to as their "intellectual property". In other words, such practitioners claim for themselves the right to keep from the patient the opinions upon which his diagnosis and treatment was determined. The patient is tagged and labelled by that "intellectual property" for his practitioner is quite happy to pass it on to any colleagues to whom he refers the patient.

Unfortunately, diagnoses are not always correct nor the treatments appropriate. In such cases, the "intellectual property" may have a profoundly adverse effect upon the subject. Not only is it his right to know that he has been misdiagnosed, the information is essential to his health if not his very life. What purpose does the practitioner who denies his patient the "intellectual property" have, if not to deny this vital information?

When testifying before a Congressional Committee on the illnesses arising out of the Persian Gulf War, Daniel Clauw said: "It is arrogant of us, as scientists, to feel that because we cannot precisely define a problem, that it doesn't exist." And in the BMJ, some time ago, Dr. M.N.C. Dukes put it another way: "Plenty of people are still dying of diseases in which other people do not believe."

With the best will in the world, innocent misdiagnoses will sometimes occur, but where they are founded upon nothing more scientific than prejudice as are the cases to whom the above refer, that is another matter.

George Bernard Shaw said: "To avoid violating etiquette, no doctor would ever hinder a colleague, however incompetent, from decimating a whole countryside." The first step to removing the ammunition for such comments, is to forget etiquette and concentrate on ethics. It is time for the die-hards to get off their shaky pedestals and admit there are still many things in their field that even they don't understand.

Gurli Bagnall