Dr Jekyll and Mr Hyde

A third-rate artist, a failed seminarian, a drop-out teacher. They don’t sound a threatening trio. But between them they were responsible for the deaths of around 150 million people.

Neither Hitler, Stalin nor Mao were medical men. But some recent lesser tyrants were doctors: Haiti’s Papa Doc Duvalier, Bosnian Serb Radovan Karadžić, and Bashar al-Assad of Syria among others.

Papa Doc’s work on controlling yaws won him humanitarian accolades, but when he entered politics he was drawn into Haiti’s voodoo culture and thousands lost their lives.

Radovan Karadžić was a psychiatrist with, apparently, a devoted following before he committed deeds for which he is now indicted for war crimes and genocide. His previous imprisonment for embezzlement suggests that his moral compass was adrift long before the Balkans sank into yet another ethnic conflict.

Reports on Bashar al-Assad’s time at the Western Eye Hospital commend his kindly treatment of patients. His father’s regime had lethally suppressed dissent, but Bashar appeared to have different values. Not now.

What turned these doctors? Belief that the cause for which they stood was worth the sacrifice of other people’s lives? French revolutionary Jean-Paul Marat, who practised in Newcastle and St. Andrews before joining the killing spree in Paris, thought so. So did Che Guevara. The responsibilities and opportunities of power may have removed restraints which in normal times would have kept them on the straight and narrow.

Politicians can distance themselves from the unpleasant realities of killing other people, though some like Papa Doc discover a taste for sadism. Nazi doctors may not have seen themselves as sadistic: they viewed the people on whom they conducted their ghastly experiments as less than human. Doctors working on chemical and biological warfare in the Japanese army’s Unit 731 may have felt the same about their victims. Should we make use of results obtained through such appalling experimentation? In the case of the Nazis, the ethical debate continues, but US general Douglas Macarthur had no such scruples: he granted the Japanese teams secret immunity in exchange for sharing their information with the Americans.

Are doctors as likely to be serial murderers in real life as they are in Agatha Christie’s novels? Harold Shipman wasn’t unique. In 1956 John Bodkin Adams was tried at the Old Bailey and acquitted of murdering two patients. He was reinstated by the GMC. Nevertheless, suspicion continued that he had killed around 160 old ladies, and was strengthened in 2003 when police archives were made public.

Other doctors have been charged with murdering a patient. Most believed they were acting to relieve suffering. Shipman is the only British doctor actually convicted of killing a patient. He didn’t claim to be altruistic, and still no-one really knows what motivated him.

Doctors, like almost everyone else, can get sucked into the prevailing culture, whether it be that of African dictatorships or racist thugs. They can get swept up by ideologies. In their work they are always in a position of power: no amount of patient involvement can fully achieve an equal balance between the confident doctor and the vulnerable patient. Doctors have the means and the opportunity to administer harmful drugs. If the culture which keeps psychopathic tendencies buried is removed, a doctor may get high on the power of life and death. It’s not surprising, either, that every now and again a doctor loses control and murders a family member.

What does this have to do with the rest of us? I think quite a lot. Doctors used to be put on pedestals, and they still retain public confidence. It's a deal: we demonstrate high professional and personal standards and in return we receive respect along with the bottle of Famous Grouse at Christmas. On a pedestal, you’re exposed. Much is expected of you and you up your game. But a doctor who is evil threatens this calculus. It sometimes feels like open season for doctor-bashing: the profession doesn’t seem to be popular with the government, or with the Daily Mail. People in power would like to control doctors: downgrade them to technicians and gag them so they can’t speak out. Stories about wicked doctors are a gift to them.

Can we identify the doctors who are going to turn bad? GPs Bodkin Adams and Shipman both had ‘previous’; early in their careers they had been caught forging prescriptions for opiates. But it’s easy to make firm diagnoses with a retrospectoscope.

Locums get an intimate view of other GPs’ work. We work in their practices, we sit in their consulting rooms, we rummage in their desk drawers for equipment, we use their computers, we read their patients’ records. What if we unearth empty gin bottles or murky websites, or notice odd prescribing habits or questionable clinical practice? Such GPs are most unlikely to be potential mass murderers, but they could be putting their patients at risk. All doctors have a duty to report colleagues if they feel their conduct gives cause for concern and, by shouldering our responsibilities, we could help save a patient and even our profession.

Judith Harvey

Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum, an LMC chair and a long-time supporter NASGP. Her charity, Cuba Medical Link, enables medical students to go to Cuba for their electives.

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