The Significance of Religious Uniforms when working with mentally ill

Photograph from Daily Mail. Click on it to read the article

For decades, if not for a longer period, there have been attempts from within the church to make changes to the tradition of wearing religious uniforms by clergy. The above photograph is of Peter Owen-Jones who has some dress sense when trying to break down the barriers in communications with the faith followers. The Church of England Synod will decide in February 2014 if they are prepared to put power first or their parishioners.

It is a very serious matter. Dress can have disastrous consequences. Sadly, for example, there is evidence that there were increased suicide rates in an area where a Catholic nun, social worker wearing her habit was appointed for about four years. 

   SIGNIFICANCE OF RELIGIOUS UNIFORM WORN BY MENTAL HEALTH   PROFESSIONALS

   

To whom is religious uniform significant	In what way is religious uniform significant
Mentally ill person	Barrier to communication It has already been established by scientific research that no uniforms should be worn in mental health setting.  Thus one finds that doctors, nurses, social workers and administrators in England have not worn any uniforms for at least thirty years. Uniforms are a barrier to communications as in “us and them”. With impaired communication there is a much decreased chance of effective diagnosis and treatment. The consequences of wearing uniform defeat the purpose of employment. Reminder of trauma Men raped by clergy as children experience flashbacks, panic attacks when reminders of trauma are presented to them. Diagnostic and Statistical Manual of Mental Disorders TR IV lists diagnostic criteria for mental illnesses. Under Post-traumatic disorder one is able to find that avoidance is one of the groups of symptoms. Avoidance means avoiding situations and people that act as reminders of the trauma. Talking about trauma is also a reminder. Even thinking about appointments with professionals when such traumatic events may be discussed can lead to anticipatory anxiety in patients with Post-traumatic Stress Disorder. Some patients have sleepless night(s) and even start vomiting when so anxious. There is no point in multiplying the barriers to communications with mentally ill people and wearing of religious uniforms does just that for many. Reminders of abuse by clergy include religious uniforms. The result can be severe panic attacks experienced by patients. Panic attacks are associated with higher mortality from myocardial infarction too. Therefore, religious uniforms represent health and safety risk in mental health setting that is preventable. Uniform symbolic of uniformity of values for the group wearing the same uniform It is would be recognized by most mentally ill people that uniform poses obligations on the wearer of uniform to conduct themselves consistent with the values of the institution it represents. This involves the sacrifice of individuality of the wearer. The issues of trust arise out of this situation. Person, who has given up their individuality and made considerable efforts at it, is unlikely to uphold another person’s right to his/her deviancy from norm (as in mental health issues) and especially so where the degree of deviance from the norm can be considerable (healthy or unhealthy). Health issues and stereotyping There may be health issues that patients would not disclose because of the fears of what religious person may think about them, for example, sexual issues, family planning, abortions, blood transfusions, epilepsy, mental Illness causing behavioural transgressions, hearing voices, feeling controlled by outside forces (as in some cases of schizophrenia) and so on. Reprisals Disclosing history of abuse by clergy to members of clergy has been very risky for victims. Now it is known that canon law requirement has been to keep the history of abuse secret from other people (including police) or risk excommunication. In communities where clergy have influenced even access to jobs fear of reprisals has been very real and not evidence of paranoia. Unemployment creates depression, and exacerbates mental illness. It can also lead to increased suicide risk. Threats of reprisals against the victims of abuse by clergy are some of the factors that prevented access to state justice system. Mental health is damaged by chronic injustice and this applies to victims, their families, and friends. It has been argued by some lawyers that aiding and abetting the crimes of child abuse happened at the top of religious hierarchy through the cannon law defects as well as lack of effective child protection measures following the disclosures of abuse. The offenders were allowed to work not just within the same religious organization but with children too while the risk of reoffending remained the same. As crimes were not reported to police there would be no Criminal Records Bureau check that would reveal anything. Authority and power v right to individuality Healthy attitude is to accept that each person is an individual. Religious uniforms represent authority and power in mental health setting as determined by state that permits it. Religious uniforms are misplaced in mental health setting as it actually ignores patients’ need to be considered as an individual who may actually hold very different beliefs and whose need at the time is his own health foremost and not to be preoccupied with what the needs of the religious person wearing religious uniform are. It is impossible to be faced with a person wearing religious uniforms and not notice it unless one is blind or has other rare perceptual disorders. This means that mentally ill person is expected to adjust themselves to the expectations of the religious mental health worker wearing the uniform irrespective of their desire, need or ability to do so. Equality issues through role modeling Mental health workers are like teachers in that they represent role models. It is unhealthy to act as a role model for values that are against equality for women, those of different ethnic groups, sexual orientation, different beliefs and so on. Religious uniforms stand for patriarchal values and outdated values which are not in keeping with the laws on equality. Anxiety Anxiety is common in many mentally ill people and introducing more anxiety by wearing of religious uniforms causes worry to patients and needless suffering which could be prevented. Putting patient in a situation where he/she has to deal with making of formal objections to wearing of religious uniforms also presents the task for mentally ill that they may not be able to do. It is unreasonable to expect mentally ill, vulnerable people to assert their rights and fight the system when even healthy professionals are scapegoated and destroyed (see example of Dr Helen Bright) when they attempt to do it. Provocation and Violence It can be said that religious uniforms can represent provocation to some patients who already may have problems with impulse control for various reasons such as high stress levels. Some patients can be paranoid and grandiose too which in itself can lead to poor impulse control and aggression towards those who are considered irritants (like those wearing uniforms). There are various cases of murders of nuns and priests by mentally ill who had a mixture of paranoid and religious delusions. The case of Mark Bechard is a well-known case and there are many others. He killed at least two nuns in the same day and wounded seriously more. Mental handicap/Learning Disability It is recognised that there are people who have severe cognitive handicaps, are very vulnerable and it can be accepted that they may be totally unable to object themselves to the wearing of religious uniforms or to even instruct anyone else to object on their behalf to the wearing of religious uniforms by mental health workers. There are sometimes large numbers of children with learning disabilities who suffered abuse in the some religious institutions. Reminders of trauma may not be verbalised but manifest themselves in behavioural deterioration which would be difficult for professionals to manage or even understand in patients with communications problems. Suicides a) Suicides can result from untreated mental illness. When barriers to communications exist as they do in human society and medical institutions for various reasons one finds increased suicide rates. Men have higher suicide rates and there is social expectation that men cannot be emotional, or sad. Gender inequality is reinforced by most major religions and for both sexes in a different manner. Sense of hopelessness may arise in patients when they see that mental health institution they want and need to trust upholds values detrimental to their health. Some religious people do not recognise manifestations of mental illness but see it as possession by evil spirits which is offensive in itself to mentally ill. We do know that medical regulator employs staff who have such beliefs. b)  In Dr Bright’s case, she had no suicides amongst her patients when working in a hospital where nun wearing her religious uniform was employed as a social worker. However, there appeared to be an increase in suicides following appointment of a nun wearing religious uniform and after Dr Bright’s dismissal for raising the issue  in the public domain. Inefficient use of Taxes It is now known that even as much as 50% of UK population would at some point in their life experience mental distress. In most case it would not come to the attention of psychiatrists. The majority of those people would be working most of their lives and paying taxes with which they would support the system that is not supporting them at all times. When wearing of religious uniforms in mental health is detrimental to patients it follows that using tax payers’ money for salaries of people wearing them is inappropriate and against the interest of the tax-payer too.
Doctors	Diagnosis and treatment a) When there is no communication or decreased or impaired communication between patient and doctor wrong diagnosis and wrong treatment may result. Wearing of religious uniforms impairs patient’ s communications with professional wearing it, and even with those not wearing the religious uniform that become associated with it in their minds. ”They are all the same” is what some say referring to all the staff after a disappointment. This occurs in depressed patients and is known as catastrophizing. The point here is that implications are wider than one might think at first. b) It is already established that not wearing uniforms is associated with better compliance with treatment, less absconding from wards, less self-harm, less violence from patients. See paper by Roger C. Rinn. Power a) Some doctors can be unfair and stigmatise mentally ill patients. This means that government policy of leaving mentally ill at the mercy of local NHS Trust policy making is misconceived when it comes to the wearing of religious uniforms by mental health professionals. There is already discrimination against mentally ill people and it is unlikely that all NHS Trust administrators would care about mentally ill or that the majority of doctors would care about mentally ill as much as about other patients assumed to be sane. b) Medical profession is self-regulated profession which means that it is possible to get rid of dissident voices over a period of time through sham peer review process using medical regulator such as the General Medical Council that has always been religiously biased. Raising the issue of religious uniforms has been a dissident voice which puts patients first and not doctors or other mental health professionals wearing religious uniforms. British Medical Association is conformist and it would support strike for doctors’ pensions for their members but unlikely to take actions on human rights for patients and especially not mentally ill. Medical ethics is that patients come first, but it does not happen in reality when religious uniforms are worn by mental healthcare workers. However, it looks very nice in print that patients come first. Values and beliefs Religious uniform may represent the values that mental health professional holds important and prefer to hold in isolation from other thoughts giving rise to cognitive dissonance such as thoughts how bad it is for the patients and staff as well as the community (public interest). Cognitive dissonance plays a role in many value judgments, decisions and evaluations. Becoming aware of how conflicting beliefs impact the decision-making process is a great way to improve ability to make faster and more accurate choices. This ideal awareness is not something that is likely to happen in medical institutions dominated by men (General Medical Council in over 150 years never had a woman President or Chief Executive) or where women are chosen for their adherence to the same values and biases as men already there have. All major religions are patriarchal and dear to some medical men for that very reason. But not all medical men are the same.
Politicians	Votes If it is accepted that religious people vote and that getting those votes could make one believe that by having religious bias at the expense of the mentally ill would lead one to have more power if elected. The assumption here is that religious people would prefer the rights of religious uniform to that of mentally ill persons. There is no evidence that in the setting of having the knowledge that uniforms (religious and non-religious) are harmful in mental health setting the majority of religious people would be unreasonable and demand special privileges to be given to those who wish to wear them. In fact, the latest statistics show that the majority of UK citizens have secular views. Power Most religions are patriarchal and that appeals to some politicians who may identify with such values. But many would not if representative of the population and if asked. Wilful Blindness Some politicians may have been well informed and knew that religious uniforms were, really, not such a good idea in mental health setting but avoided dealing with the issues by creating a good work wear policy because of cognitive dissonance and desire to eliminate it by extolling the virtues of religion because of all the previous personal investments made in religion.
Religious Institutions	Free Marketing When religious uniforms are seen in the setting where some good is done (health and social care) religious institutions get free marketing because religious uniforms are symbolic of religious institutions and their values. Doing the job of mental health professional while wearing the religious uniform is perceived by observer as the work of religious institution.
	Power Having the “right” to use religious uniforms when other mental health professionals are not allowed to do so places religious institutions in the positions of power and special privilege. In fact, there is no such right in law. It becomes impossible not to consider the needs of the religious person in all interactions between professionals and patients when religious uniforms are worn. Both professionals and patients have at all time to consider what to say and what not to say in fear of offending the religious and the institutions behind them. Like in dysfunctional families one is walking on egg shells. It is so very easy to offend the religious.
	Financial benefit Religious uniforms are also provocative and divisive. Firstly, scientifically minded professional is provoked to react to it. Similarly, person with sense of justice could do the same. Secondly, it is possible to eliminate competition from scientifically orientated professionals by claiming religious rights, establishing those rights as dominant rights and thereafter benefiting financially when scientific competition is firstly discredited and subsequently destroyed and eliminated from the workforce. In the case of Dr Bright, she was dismissed and erased from medical register while the nun was promoted and remains registered with Social Care Council. The rights of mentally ill have not been considered by anyone and how many died. This is breach of Article 9 of European Convention on Human Rights because religious rights are not absolute rights as well as breach of  Article 2.
General Public	Right to expression of religious belief While public recognize the right to religious beliefs public expects politicians to put their health first as well as the health of mentally ill. This would be in keeping with European Convention on Human Rights Article 9, having the proper balance of different rights.
Mental Health Institution	Image and values In UK so far the social and cultural background of institutional administrators determined preference for the religious uniforms while disregarding the needs of the mentally ill. No policies were created that eliminated the wearing of religious uniforms anywhere in UK while it has been acknowledged that no uniforms are worn in mental health setting normally. Power Where there is power there is potential for abuse of that power. Low social status of mentally ill people and low power of mentally ill enabled religious bias to dominate with fatal consequences. Religious uniforms may be symbolic of values to which some administrators aspire.
Justice system	High prevalence of abused males In a number of studies in penal settings in Europe and elsewhere it has been established that there is high prevalence of men who have suffered abuse as children including sexual. The incidence is about 70%. Considering the link of traumatic experiences to that of offending one would have to consider the impact of religious uniforms when visiting prisoners some of whom may have suffered abuse by clergy. There are men in UK prisons who have killed clergy members following experiences of abuse by them.
Military	Murders by religious psychiatrist wearing religious clothes 2009 USA Army base incident (Fort Hood mass shooting by Dr Nidal Malik Hassan who killed 13 people and wounded 29) is a good example of failures to assess the risk to army personnel. Here psychiatrist was seeing army personnel some of whom would have post-traumatic stress disorder as the result of the war in the country where predominant religion was Islam, the same as that of the psychiatrist who dressed in ethnic clothes identifying him as a Muslim. Patients with Post-traumatic stress disorder can be very irritable and provocative and religious uniform is provocative itself. The combination was fatal for many. This incident happened 10 years after Dr Bright warned about the wearing of religious uniforms in mental health setting in UK which was published worldwide.

Overcoming Racial/Ethnic and Complainant Status Discrimination with anonymized complaints

It is not known for how long people have discriminated unfairly on the basis of names alone (?thousands of years). What is known is that, for example, exams, when taken anonymously (with number as the means of identification of person taking exam) eliminate some forms of discrimination and would do so particularly in multiple choice type exams when one has to tick box for correct answer.

Medical profession is fully aware of how to avoid racial/ethnic discrimination in regulatory process. All doctors have taken more exams than they can remember in which their names were anonymized. So why do they not apply it to medical regulation? It is known that most of the doctors struck off the medical register are those of ethnic minority. Complaints against doctors made to GMC are not anonymized and neither are the complainants. So, unfair discrimination against both doctors and complainants occurs every day.

The General Medical Council (GMC) regulator of medical profession in UK employs Professor Aneez Esmail and Dr Sam Everington. Many years ago, these two doctors performed research in which they created false doctor's curriculum vitae (cv) and made two sets of  copies differing in that one set had an English name and the other one Asian. They sent these CVs in response to the job advertisements in the National Health Service. CVs with Asian names had disproportionately smaller chance of being shortlisted.

The research findings by Professor Aneez Esmail and Dr Sam Everington have not been implemented to change the regulatory process. Many lives would have been lost because there is a shortage of doctors and particularly so in unpopular specialties. When good doctors are removed from practice people do die. It would appear that the priority in medical regulation is not public interest but self-interest such as keeping the numbers of doctors down and the price of the product high (demand and supply economics).

Shocking news, but is it true that the majority of British single men only wash their bed sheets once every three months?

Photograph of a dust mite. They eat human skin cells shed by us all the time. Delicious! Some people develop allergy to dust mites with asthma, which can be life threatening. Read about it HERE.

To learn more about the shocking survey about British people having very poor bed hygiene click HERE:
The majority (more than 70%) of single men according to the survey wash their bed sheets once in three months! The majority of the British population do not appear to have the recommended levels of hygiene either (yes, bed sheets should be washed at least once a week).

Considering the high incidence of asthma (and rising) in other countries of the world. one is asking about what other countries look like in terms of their hygiene habits. At least 180,000 people die each year from asthma.

Naturally, there are people in UK who have good standards of hygiene but according to the survey these are in minority.

Dr Gordon Skinner

"I learned that to humiliate another person is to make him suffer an unnecessarily cruel fate " Nelson Mandela

 

Dr Gordon Skinner has died from a stroke, Doctors4Justice has been informed just now. He fought to increase the standards of treatment for patients in UK who have clinical symptoms of hypothyroidism but according to British Standard range for thyroid blood levels were considered normal in them. Please, click on his photograph above to read more about Dr Skinner's work. It is known that different countries have different standards, and of course, different standards of well being.
For about 11 years he had various General Medical Council disciplinary hearings because GMC could not cope with his reasoning. Disciplinary hearings are felt as a huge public humiliation. Such stress is known to be associated with the higher risk of dying from myocardial infarction, and strokes.Read HERE about Humiliation its nature and its consequences.


Results of search on: 28 Nov 2013 at 20:04:30. The details shown are valid at the date and time of the search only. (well , they are not, Dr Skinner has died)
GMC Reference Number 0726922
Given Names Gordon Robert Bruce
Surname Skinner
Gender Man
Primary Medical Qualification MB ChB 1965 University of Glasgow
Status Registered with a licence to practise; this doctor is on the Specialist Register
This doctor has conditions
Conditions on the doctor's registration
From To Condition
23 Nov 2013 23 Jul 2014
1. He must notify the GMC promptly of any professional
appointment he accepts for which registration with the GMC is
required and provide the contact details of his employer.
Details
2. He must allow the GMC to exchange information with any
employer he may have or any contracting body for which he
provides medical services.
3. He must inform the GMC of any formal disciplinary proceedings
taken against him, from the date of this determination.
4. He must inform the GMC if he applies for medical employment
outside the UK.
5. a. His clinical work in relation to prescribing of thyroid
replacement therapy must be supervised by a named Consultant
Endocrinologist. This means that his day to day work must be
supervised by this consultant who may be off site but must be
available to be called if necessary. However, as a minimum, his
work must be reviewed at least once a fortnight by the
supervising consultant. This review should include regular case
based discussions, with reference to his logbook. This logbook
may additionally be provided in an electronic format agreed with
his supervisor. b. He must seek a report from his supervisor for
consideration by this Panel, prior to any review hearing of this
Panel.
6. In any patient with normal thyroid function test results and
with a history of cardiac disease, he should not initiate treatment
with Thyroxine without first having an opinion from the patient’s
cardiologist or GP, which should be recorded in his logbook.
7. He must keep a contemporaneous logbook of all patients for
whom he prescribes or recommends thyroid replacement
therapy. This book must identify the patient only by their initials
and NHS number together with the name and contact number of
the referring practitioner, and should be initialled and dated by
the patient. a. The logbook he keeps must indicate: i. The reason
for the prescription of thyroid replacement treatment; ii. The
most recent thyroid blood test results, dated, regardless of
whether or not the blood test was carried out by a general
practitioner or himself; and iii. The dose he has prescribed or
recommended of thyroid replacement treatment. b. This logbook
must be available for consideration by this Panel, prior to any
review hearing of this Panel. In addition, any electronic version of
the logbook should be available to the Panel.
8. He must inform the following parties that his registration is
subject to the conditions, listed at (1) to (7), above: a. Any
organisation or person employing or contracting with him to
undertake medical work b. Any locum agency he is registered
with or applies to be registered with (at the time of application) c.
Any prospective employer or contracting body (at the time of
application).

He would have found the above conditions unbearable and hugely damaging to him.

He will be missed much by his family and his patients who depended on him for their treatment. We were thought at medical school that we treat the patient not the blood test.

Petition for Confidential Inquiry into deaths of doctors subject to investigations by The General Medical Council in UK

The petition to Ministry of Justice asking for Confidential Inquiry into deaths of 100 doctors who died while investigated by the GMC has now closed with 2109 signatures most of these from doctors, presumably.

End of Life Monitoring and Assessment

Click on the image to read about ELMA, improving efectivness in care at the end of life.

English judges grip the fence

For some time now it has been recognized that British courts are biased when it comes to religion. Therefore, one perceives failure to be independent, and act in accordance with the law which presumably, demands fairness, truth and justice.

The most recent exposure of judges attendance at Westminster Abbey service at least once a year is just one example of how not to do public relations. While it may pain some judges to attend irrational ceremony or amuse others the impression one gets is that of judicial conformity beyond the necessity. It certainly is not impressive to see judges praying for anything and especially, not for the divine guidance. Do they not see that? Very embarrassing for the judiciary. Also it looks very oppressive for the state to treat the judges in this way.

Photograph from Guardian, click on it to read the article by Joshua Rosenberg

There is nothing to stop the judges from saying a little "No" to this outdated tradition. So, why not put that on their agenda?

If the judiciary feel the need for a bit of ceremony and socializing at the start of each legal term there are professional performing circus artists, stand up comedians, party organizers, massage therapists, anxiety management therapists, sport competitions (swimming is good as are martial arts), leadership courses, meditation classes, musicians, dancers and numerous entertainment venues.

Click here to watch an innocent dance by a Pakistani judge on UTube. He resigned after it. We do not know if it was to take up some dancing lessons. 

Here are some costumes for the judge. There are countries like Greece and Norway where judges wear business suit. Yeah, why not look smart in Armani or whatever suits you. Fashion and dignity.

Interestingly, Serbian Judges Association started with a slogan: "I do not agree"

Judge Murphy and the veil

Photo from Daily Mail http://www.dailymail.co.uk/news/article-2400844/Judge-orders-Muslim-woman-remove-burkha-court-appearance-bans-entering-plea-refuses.html

For sometime now UK has failed to ensure social justice when it comes to religious expression. Many professionals are obstructed in their attempt to do their job properly because of the bias towards religious expression.

Recently, Judge Murphy in London had difficulty with a witness who covered her face with a veil on religious grounds. This posed a problem of identification but also a problem in the exercise of the professional duty as a judge. It is an accepted legal practice that facial expressions, tone of voice and mannerism of witnesses do matter in courts.

Whatever Judge Murphy decides with respect to the wearing of  the said veil there could be objections: if he permits the veil there could be objections to that as other witnesses are judged on their verbal expressions, tone of voice, mannerisms. 

If he allowed witness to be screened from public view while without veil then he risks public hearing not being what many may expect it to be. Public present in court would want to see the witness too. It is not mere curiosity. Public also look at facial expressions, mannerisms, listen to tone of voice of witnesses. Similarly, those judging them are observed. How can one judge a judge's decision making or questioning when one does not really know what behaviour of witness he/she may be reacting to?

This mess can be solved politically, but UK is unlike France which published secular charter in all schools and is a secular state.

Judges have suffered in other European countries too, for example, an Italian judge Luigi Tosti in his attempt to remove cricifix from the courtroom. 

Here is Luigi Tosti's blog.

DOCTORS4JUSTICE: Foreign doctors and language skills

http://epetitions.direct.gov.uk/petitions/54034DOCTORS4JUSTICE: Foreign doctors and language skills

Foreign doctors and language skills

The situation in the UK (United Kingdom) is not good. More than 100 doctors died while investigated by the General Medical Council (GMC), the regulator of medical profession. Tens of thousands of patients died in NHS (National Health Service) hospitals unnecessarily and yet there are many regulators in healthcare.

For some time GMC expressed their view that they need new legislation to allow them to test foreign medical graduates' language skills. The facts are that such legislation is not required. European countries ask foreign graduates to provide certificates of proficiency in the language. Germany does and so do other European countries.

Is there such a thing as Cambridge University in the UK? Do they know about English Proficiency teaching and certification? Of course, of course, but power games and manipulation has been the problem in regulation of medical profession for some time.

 

Hunt stands up for equality

Rt. Hon. Health Secretary Jeremy Hunt has made a stand for equality by raising questions about CPS decision not to prosecute two doctors found to be performing abortions based on sex only which is illegal. Telegraph carried out investigations. It is not clear why CPS considered it not to be in the public interest to prosecute.

 GMC does not always prosecute doctors who break the law, and allows corrupted individuals, for example, to remain on the medical register. 

Since 2004 over 100 doctors died while investigated by the General Medical Council. The reasons remain unclear and D4J is asking for confidential enquiry why this happened.

Click on the photograph from BBC website to read their report.

Stop the badger cull or Stop the doctor "cull"

The e-petition Stop the badger cull is doing very well, indeed, and has secured more than enough votes to lead to a debate in the House of Commons.
Meanwhile the Petition for Confidential Enquiry into deaths of hundred doctors who died while investigated by the General Medical Council is proceeding at a much slower pace. That is England for you at the moment.
To sign the Petition demanding Confidential Enquiry into deaths of 100 doctors who died while investigated by the General Medical Council CLICK HERE.

Day 7: Petition for Confidential Enquiry into deaths of 100 doctors while investigated by the General Medical Council

On day 7 we have 286 signatures by 10 pm.

At least 60 more people have been emailed today about this Petition

What matters now is that those who signed the petition ask/forward email with link  to petition to as many of their contacts as possible for them to sign the petition and forward on .

We can see that not all of those who signed the petition have done it.

 Our message is: have the courage of your convictions. Do ask other people to sign your petition.

MORBIDITY AND MORTALITY IN DOCTORS VISITED BY MEDICAL MISFORTUNE by Dr M. Donnelly

 MORBIDITY AND MORTALITY IN DOCTORS VISITED BY MEDICAL MISFORTUNE.

The purpose of this paper is to raise further concerns about medical practitioners visited by medical misfortune.

The paper describes how social medicine focuses on the social determinants of health but it rarely focuses on the social determinants of the health of medical practitioners who may be visited by ill health or medical misfortune leading to disciplinary processes and ill health.

There is little written formally about the epidemiology of medical misfortune but we know that it may occur unexpectedly challenging the practitioner and demonstrating that in these situations the practitioner may well be on his or her own, frequently deserted by colleagues.

In 2004, in the United Kingdom, sanctions were made against 315 doctors; 82 erasures, 116 suspensions (64 on health grounds) and 117 conditions on registration (64 on health grounds). In 2003, of 214 doctors subject to GMC supervision, nine died, giving a case fatality rate of 4.2%, twice the death rate from coronary artery by-pass surgery. After the deaths of four soldiers at Deepcut Barracks in Surrey, a mortality of 0.03 per cent (throughput of 12,000 soldiers), Amnesty International called for a Public Inquiry. The trend has been downward since the National Audit Office documented the £40m spent on suspensions (the most frequent challenge) to the Public Accounts Committee..

If the morbidity and mortality amongst such medical practitioners is not addressed, more health service resources will be wasted, morale amongst medical practitioners will continue to fall and recruitment to the medical profession may adversely be affected.

1. General Medical Council. Annual Report 2004. General Medical Council. London, 2004.

E mail: ddddonnelly@hotmail.com