The Doctor’s Surgery Theodore Dalrymple
Theodore Dalrymple: The Doctor’s Surgery
He who pontificates must read. So I have spent the past couple of days ploughing through the report on the Gosport War Memorial Hospital scandal.
For a number of years, strong opiates were prescribed and administered there to elderly patients (a number of them no older than we are) in what might be called a careless or even cavalier fashion. It is suspected that many of them had their lives shortened as a result, though to prove this beyond reasonable doubt in any individual case might, for technical reasons, be difficult.
I could not help recalling, as I read, the case of Dr John Bodkin Adams, the Eastbourne GP who, in the 1950s, was tried for the murder by opiate of a patient, suspected to have been one of many. Dr Bodkin Adams was the subject of one of the great comic poems in the English language, whose author remains to this day unknown:
In Eastbourne, it is healthy And the residents are wealthy. It’s a miracle than anybody dies; Yet this pearl of English lidos Is a slaughterhouse of widows – If their bankrolls are above the normal size.
Dr Bodkin Adams (than whom no man ever looked more like a surreptitious poisoner) was suspected to have had a pecuniary interest in his patients’ deaths:
If they’re lucky in addition In their choice of a physician And remember him when making out
their wills, And bequeath their Rolls-royces Then they soon hear angel voices And are quickly freed from all their earthly ills.
Dr Bodkin Adams was acquitted. The Gosport report discovered a culture of incompetence ranging over many different institutions, in which bureaucracies as elaborately layered as a millefeuille pastry contrived to do nothing, though conceptually the problem they were supposed to solve was simple.
The report reminded me also of the time when I was asked to investigate six untoward and unexpected deaths within a hospital trust.
I was asked whether there was any common factor that accounted for the unexpected deaths; apart from the stupidity of the staff, I found none. That stupidity, incidentally, was not natural. It was induced by meaningless procedure – the only solution to which, of course, was even more procedure.
When I informed the medical director of the trust that the only common factor I had found in the six deaths was stupidity, I expected him to be furious and exclaim: ‘How dare you impugn my staff like that!’
On the contrary, he sat there like Buddha under the Bo tree and said calmly: ‘That is the standard expected these days.’
The Gosport report makes one very serious error, in my opinion. It states near the beginning, ‘Opioids are of immense value in the management of acute and chronic pain…’ Unfortunately, it is the belief that opioids are of value in the management of chronic pain that, indirectly, has led to the deaths by overdose of about 300,000 people in the United States since the turn of the century.
Starting from the correct observation that very few, if any, patients become addicted to strong opiates after having been treated with them in hospital for acute pain, the incorrect and disastrous conclusion was drawn by many doctors that they would be all right for people with chronic pain, too.
But this was a completely false inference, as the doctors should have known. Opiates are generally ineffective in chronic pain, and their use leads to all kinds of problems. It is most unfortunate that so castigating a report should make so serious an error of judgement, fraught with dangerous consequences.