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No Profession for Old Men

Posted by Dr No on 21 November 2013

no_country_for_old_men.jpgDr No made no secret of the fact that Dropping Like Flies was a quick and dirty assessment of whether the apparently very high number of deaths among doctors subject to GMC Fitness to Practice investigations was something to be concerned about. He concluded it certainly was, because on that crude assessment – crude because there was no attempt to adjust the figure for factors that might influence the death rate – it appeared that these doctors were at least fifteen times more likely to die than ordinary members of the working age population. The ratio of fifteen to one was, he believed, an approximate answer to the right question rather than a precise answer to the wrong question. It was, he argued, so gross in scale as to make it very unlikely, though not impossible, that the finding had arisen either by chance, or by a sufficient number of unadjusted for factors, such that being caught on Stilton’s prongs was not one of them.

But even then chicken and egg questions abound. Perhaps the doctors had come to Stilton’s notice because they were already impaired not just in their practice, but also in heart and mind. But still, fifteen to one is one hell of a ratio, and prima facie, it demands further investigation. This, indeed, was the purpose of Helen Bright’s ePetition calling for a confidential enquiry into the deaths, which closed yesterday with barely 2000 signatories – less, to put it in perspective, than one percent of all registered doctors on Stilton’s List. The small number would be laughable were it not so lamentable. Why is it that we appear to care so little about the fate of these doctors? Even the great Clare Gerada, who last year gave public attention to the deaths, this time round found that she had other, bigger bicycles to ride.

One possible reason for the apathy, Dr No suspects, is a lingering belief that these doctors, who tend to be old, male and foreign, are the runt of the profession, tattered coats and stinking goats who – though this never be said openly – somehow deserve their paltry fate. Add no smoke without a fire populism, and a Denningist regulatory awe of the law – better to bang up a few innocents than the law be impugned – and perhaps, just perhaps, it becomes a little easier to imagine that some might look the other way when Stilton’s goons cart off a colleague to a looking glass world not of Byzantine light but by eponymous darkness.

All that is as it may be. If Dr No is going to succeed at poetic allusions, he will have to lock himself up in the tower more often. Meanwhile, he has returned to the mortality ratio, to see if he might improve its veracity. Dropping Like Flies needed quick and dirty, and for that Dr No used the all working age mortality as the standard population to determine the expected number of deaths. But such a determination takes no account of (within working age) age, a major determinant of mortality, and perhaps likely in this case to lower; expected mortality, and so increase; the ratio, since the population pyramid for the medical profession is pear shaped – more younger people – than the general population, which is more barrel shaped, with ages spread more evenly across the working age age-bands.

Unfortunately, although we know the age and sex of those who died, and of doctors overall, we do not know the age distribution of those at risk, the doctors caught up in Stilton’s petticoats. There are proxy data (time since primary medical qualification) available, but they cover only two years, and the bands are broad and combine both sexes. But one thing we do know is a doctor’s socio-economic class, itself another major determinant of mortality, with those in lowest socio-economic class almost twice as likely to die as those in the highest. Doctors, ipso facto, are socio-economic class one (NS-SEC1: higher managerial and professional), and so can be expected to have a significantly lower working age mortality than the general working age population. So what happens if instead of using all working age mortality as the standard, we use that of SEC1, and so in effect compare FTP doctors mortality with that of their peers in SEC1?

Of course the ratio is going to go up – with even more doctors are dying than we might expect - but Dr No was unprepared for the extent of the rise. The mortality ratio (see footnote for calculation) rises to a staggering 3077 – FTP doctors die at over thirty times the rate of their SEC1 peers. Thirty to one. If that isn’t reason for Lady GaGa to get off her bike and put her shoulder to the cause, then Dr No doesn’t know what is.

Footnote: Data sources and calculation: we know that at least (the figure is almost certainly an under-estimate, and yes older male doctors are over-represented) 91 FTP doctors died over eight years, however only 64 (including one 24 year old) of those were working age (M 25-64, F 25-59), giving an average rate of 8 working age deaths (64 ÷ 8) per annum. We also know (from the GMC’s annual FTP Statistics reports) that the population at risk – doctors undergoing FTP investigation - was around 282 each year, both sexes, with some over working age, so let’s say pro rata (age 64/91; gender 81/91) were of working age and male, giving us a revised population at risk of around 180 males and 20 females. For 2008 (middle of the period), age-standardised working age death rates per 100,000 for SEC1 from ONS were around 137 for men and 88 for women. Applying these rates to the population at risk, we get an ‘expected’ figure of 0.26 (no, Dr No doesn’t know what 0.26 of a death looks like either), and putting this under the observed deaths (O/E) gives us a ratio of 30.77, or 3077 when rebased as normal to 100.

Footnote to the Footnote: the roughly 90:10% male:female split in the FTP deaths is somewhat mirrored (85:15%) in GMC data covering three years of FTP activity by gender (links here), such that Dr No considers it sufficiently robust to include gender (also a major determinant of mortality – see figures above) in the analysis. The 3077 ratio thus takes into account both SEC and gender for working age FTP doctors (we have compared FTP doctor mortality with that of SEC1 peers of the same male/female distribution), and, until such time as we have more data, Dr No believes the thirty times more deaths than expected represents the best available estimate of the excess mortality attached to FTP investigation.


Sadly I think few really care about increased mortality of those awaiting FTP hearings Dr No, after all, when being squeaky clean, the apparent findings are meaningless and of course there is the presumption that there is no smoke without fire

Whether these deaths were ‘natural’ or otherwise – as in taking ones own life –needs to be investigated (cheers Helen Bright and Dr No) and indeed is - or is it? Is the survey a means to appease those who highlight such concerns and merely window dressing and/or if a presumed concern is expressed (by doctors completing the survey) with regards to the GMCs FTP procedures – will change be initiated?

A perusal through FTP hearings – where it is noteworthy that some doctors excluded themselves from the hearings etc which may or may not suggest admitted guilt - would suggest the outcomes were fit and proper – but that is not the issue here, the issue being the lack of support given to doctors, the presumed guilt and time taken from complaint to panel hearing and the detrimental effect of this on physical and mental wellbeing.

This practice of delay also applies to those who fall under the hammer of the NMC in ((presumed) lack of) FTP cases and the mind-mess that goes with it. An ex-colleague (and friend) describes his experience as a living hell – where an unfounded vexatious allegation led to his suspension (no smoke without fire and thus presumed guilt and must be seen to be doing something) and his fall into the depths of despair until two years later when he was cleared of said allegation. He received no support from the NMC whatsoever and sadly left nursing and is a sad loss to it. (His despair/depression continues)

He reports: Unless you have been in that situation you can never understand it – it will mean nothing.

And I do not doubt this to be true.

Anna, the problem with vexatious allegations is the lack of any mode of sifting before they end up under full investigation. It leaves health professionals vulnerable to attack and in situations where they find it impossible to defend themselves from it.
For example a colleague of mine was accused of having secretly treated his wife for a serious mental illness for years. But he hadn't and his wife had never had a serious mental illness. What followed was enough to make anyone unwell. He never discovered the extent the inquisitors went to until long after the matter was closed. It stemmed from this; he took his wife to his surgery and called a GP colleague in another surgery for a verbal order for diazepam because she was anxious after a personal event. They live in a remote location and he knew he shouldn't prescribe it himself. In other words, he followed the rules and got her an order from another GP a few hours up the road. It took 18 months to clear his name. The coward (a clinic manager with a grudge) was never sanctioned for her ridiculous and misery causing allegation. The end product is he'll take early retirement and flick a V sign up to the regulator.
I can understand why some health professionals cannot be bothered to defend themselves and remove themselves from the register. Why spend a huge proportion of your retirement fund defending yourself? It doesn't mean they are guilty, just that they aren't prepared to go through the terrorism that follows a notification to the regulator.
Sadly I cannot see it getting any better, however in a few years, once more clinicians have been affected by this issue, the noise from within the professions will get louder. We can only live and hope.

Dr No footnote: Subject line - 'Anne' changed to 'Anna' on 7th Jan 2014

Dr Russell Reid, who saved my life twice in 1988 and 1991, was subjected to a public trial by David Batty in the Graun between 2004 and 2007.

One of the witnesses used against him was Paula Rowe, a self confessed liar who had already been in the GRAUN telling lies to Batty who has written online that because he is gay and mixed race he makes his journalism fair and accurate.

Reid was court-martialed after being reported by "Professor" Richard Green and a bunch of his colleagues.

Green is hated by many of his former patients and his arrival at the GMC in 2007 was announced by an exclamation of "here comes Satan!"

Green's writings are quoted on the website of the North American Man/Boy love association.

"Membership in the ... North American Man/Boy Love Association is not required in order to question whether every instance of intergenerational sexuality is damaging."

~ Richard Green, professor of psychiatry, University of California at Los Angeles,
in his book, Sexual Science and the Law. Boston: Harvard University Press, 1992.

But that is the tip of the iceberg as far as Green's promotion of sex crimes against children are concerned.

Marcello Mega has written about Green's relationship with Thomas O'Carroll, Britain's most notorious convicted child pornographer in The Times Higher and his excellent article may be found online.

Green may be found defending his old colleague Professor John Money against David Reimers allegations that Money sexually abused Reimer and his brother in a BBC Horizon documentary on utube.

Reimer and his brother were the victims of a famous Mengele style twins experiment by Money at John Hopkins. Reimers brother killed himself in 2002 and David shot himself on the morning of May 4th 2004. Their mother also attempted suicide.

The documentary and other info may be found by putting "David Reimer" into Google.

A recent Freedom of info on the GMC has revealed total chaos and incompetence on the part of the administrators. I will be delighted to share this with anyone who thinks the GMC is cooput and unfair

haha. i like how you adapt various movie titles, or advertising posters, to a specific situation. I have this habit too.. in this case, i used to say no money for young men.