Professional secrecy and public faith allow doctors to get away, literally even, with murder

I realised that my relationship with my one-time GP was foundering when I discovered that my surgery file consisted of a note of two old prescriptions and assorted press clippings. Clearly Dr X felt it necessary to do a clinical audit of what I wrote, since I had once alluded in print to his practice. As he explained, this unrespectful reference breached the sacred bond of trust between doctor and patient.

It was a fragile tie. Dr X had recently arranged to admit my older son to hospital late on Christmas Eve with suspected leukaemia (actual diagnosis: mild virus). Some time later, he advised cancelling a second child's holiday because flying would rupture both his eardrums (actual diagnosis: mild infection). It was only when a practice locum prescribed vitamin-rich satsumas as a remedy for what turned out to be viral pneumonia that trust was restored.

Thereafter, dealing with Dr X seemed simple. Any ailment designated life-threatening could be cured by two Strepsils, while complaints dismissed as time-wasting trifles would normally merit an updated last will and testament and a paper in the Lancet. It did not occur to my family to switch surgeries. However perverse Dr X's advice, we retained an inexplicable faith that he knew best.

From harmlessly erratic GPs to incompetent surgeons, the medical profession basks in consumer credulity. The women who this week detailed their charges against Rodney Ledward - the gynaecologist banned for serious professional misconduct - may have been too embarrassed to complain earlier. But squeamishness does not explain the delay in outing Ledward.

Many allegations of needless abortions, continuing pain and bungled surgery went back a decade. Once the "fastest gynaecologist in the south-east" - a man who performed hysterectomies as if filleting fish - Ledward is now dubbed "the Butcher", an arrogant misogynist who once roamed the wards in hunting gear. But for the intervention of a colleague, Ledward might still be doing his John Peel impression. His victims would have remained silent, unwilling or powerless to speak until public odium offered a conduit for complaint and legitimacy to their fears.

Frank Dobson's call for national auditry in the wake of the Bristol heart scandal suggested a kneejerk reaction. Now the only question is whether he has gone far enough.

Health service complaints have risen threefold since Bristol, and the BMA is unhappy over a "rash of suspensions".

Meanwhile some trusts reveal their internal audit figures. Others still choose to hide them from their own management. The General Medical Council, newly empowered to investigate "performance deficiencies", has eight major cases in the pipeline. Whatever horrors the council might uncover, or sanctions it may impose, will remain confidential, on the grounds that the pilot-scheme is "remedial rather than punitive".

Secrecy remains a collusion involving practitioners and patients. If the latter are kept in the dark, then so are the former - denied, in the absence of national outcome figures, any evidence as to whether they are excellent or abysmal at their job.

The government solution of audits and a new inspectorate will offer some remedy. But clannish and insecure doctors make reluctant whistleblowers, and Dobson's inspectors will call only once every four years.

Most doctors, it is true, have nothing to hide. Most patients have less cause to fret over whether their operation will be botched than whether it will be done at all.

Even so, bad doctors flourish behind a double veil of security; professional secrecy and public faith based less on deference than on self-protection. It is more comforting to believe that a consultant is a shaky-handed Dr Kildare, rather than a disgusting old groper; just as it is easier to believe that a premature baby dies because nothing can be done, rather than because no intensive-care cot is available. We are gullible partly through ignorance, but also through choice.

That is why up to 180 women are only now making the connection between Dr Rodney Ledward and a spoiled life. It is why other members of the Dewhurst branch of the medical profession think themselves inviolable and why it is incumbent on Frank Dobson to ensure that they are not.

This article first appeared in the 20 November 1998 issue of the New Statesman, A prejudice as American as apple pie