The Sunday Times, Uncategorized

December 9th, 2007

Your attitude will be the death of us, doctor

Of the many strange sayings of President Bush, my favourite is, “The trouble with the French is that they have no word for entrepreneur.” In his inimitable way, Bush both disproved the point he was making and demonstrated that the French do indeed have some wonderful expressions that we lack. English would be much poorer without borrowed phrases such as je ne sais quoi, savoir faire and countless others.

One that sprang to mind last week, as I read about the paediatrician struck off by the General Medical Council for serious professional misconduct, was déformation professionelle. There isn’t an equivalent here. It is the slow process of deformity brought about by a demanding trade or profession, of its nature, rather as a ballerina’s toes are slowly distorted and damaged by her art.

In many cases professional deformation goes with an excess of zeal. Hairdressers are all too inclined to cut hair, whether it’s necessary or not, because haircutting is what they are trained to do. If one exists to solve a particular problem, one tends (and needs) to see that problem everywhere. So occupational bias often goes with zealotry. When it does it can be destructive, as in the case of the disgraced Dr David Southall.

The déformation professionelle of doctors is arrogance and sometimes unfeeling arrogance as in Southall’s astonishing case. I am not one of those people with a prejudice against doctors. There are doctors in my close family and among my friends.

All the same, given their power over life and death, and in Southall’s case, over parenthood, and given the superiority of their knowledge (real or imagined) over people in their power, it would hardly be surprising if some of them were to drift into arrogance. By arrogance I mean a loss of that modesty in the face of life’s great complexity and one’s own shortcomings that is an essential part of wisdom.

In medicine another hazard is emotional coldness. From the earliest stages of their training, doctors are confronted with other people’s fear, pain, grief and death. I can never forget my brother’s accounts of his distress as a young doctor. One of the ways doctors deal with this is to distance themselves from people’s feelings and repress their own. Otherwise they could not function. There must be a balance between professional distance and acquired insensitivity, to say nothing of doctors who arrive at medical school insensitive and arrogant by nature. Any natural deformity will be made worse by the profession.

Southall is a man whose arrogance seems breathtaking. In 2000 he felt able, after watching a Channel 4 programme about Sally Clark, then wrongly in prison for murdering her two baby sons, to ring the police and tell them he suspected the father was the murderer and might harm the remaining child in his care. Southall came to this conclusion without seeing any medical or postmortem records. His accusation was based on his expertise, whatever that can mean in such a context.

To accuse a bereaved father, whose wife is in prison for murdering their babies, of committing the crimes himself, with a view to having his remaining child taken away; to do so without the most carefully examined evidence; to intrude in the case without a professional invitation and worst of all to do so when he was prohibited from intervening in such cases because he had been suspended; and to fail to apologise to the Clarks, strikes me as déformation professionelle at its most monstrous.

The General Medical Council found Southall guilty at the time of serious misconduct and banned him from child protection work for three years. Three years later, last Tuesday, the GMC struck him off the medical register for other reasons. Complaints had been made to the GMC about Southall, including the removal of nearly 4,500 hospital case notes to his own files. The panel spoke of his “multiple failings over an extended period” and his “deep-seated attitudinal problems”, but what finally got him struck off, among other things, was his treatment of a woman whose 10-year-old son had hanged himself.

Southall accused this mother, to her great distress, of drugging and hanging the boy herself; this was in front of a senior social worker who was considering removing her other child. He also brought up with this unhappy woman another possibility, only to dismiss it, that her 10-year-old had died in an autoerotic sexual experiment. The scene as Southall himself described on Radio 4 sounded almost insanely insensitive and improper and would have been so even had the mother been guilty, which she wasn’t.

What is disturbing is that many paediatricians and other doctors support Southall. They claim that he is being hounded by a determined campaign to deny the existence of child abuse. This is nonsense. The country is obsessed with child abuse. So far from denying it, we all suspect it or are encouraged to suspect it everywhere. What Southall is guilty of, and what parents everywhere hate and fear, is extreme arrogance, insensitivity and a general indifference to rules, combined with astonishing power. That is bad in anyone but it is completely unacceptable in a paediatrician dealing with other people’s babies and parents’ rights to keep them.

Paediatricians such as Southall, and social workers, have impossibly difficult jobs. With the best of intentions they might accuse an innocent parent or be tricked by a guilty one. They may often be wrong for the right reasons, or for reasons that though wrong are conventionally accepted.

There may often be telltale signs of abuse when, in fact, there is no tale to tell. Later scientific research may suggest other explanations. Southall’s mistakes may be just that. His real crime is his attitude: his insensitivity and his overconfidence, wrong though he has often been, in what he keeps coolly calling his expertise, as if there were any objective expertise in such cases. Other paediatricians should not try to protect him. If they do, they will bring themselves and child protection into disrepute. And they may be suspected of another déformation professionelle – a tendency in doctors to close ranks, right or wrong.