Dr 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.
Ploughing through General Turkey Council Fitness to Practice data with a tractor ever more bogged down in numerical mud, Dr No got distracted by another question: what do ‘erased’ – the chilling term used by the GTC in place of the plebeian ‘struck off’, chilling because where the plebeian leaves a name albeit with a line through it, erasure effects obliteration, total obliteration, for not even a name remains – doctors get erased for? In the past, one was encouraged to suppose it was the three As, alcohol, advertising and adultery, a supposition borne out by the General Medical Council’s, as it was then, 1965 ‘Blue Book’ guidance, which does indeed list the three As (alcohol comes under splendidly archaic ‘Offences Indicative of Tendencies Dangerous to Patients’ heading), along with other examples of ‘infamous conduct’ likely to bring a doctor to the Council’s attention. But over time, as two of the capital As have become, so to speak, of lower case severity, we might suppose that ‘gross neglect in diagnosis or treatment’, the 1965 heading for clinical failings, might have risen in prominence, such that today most doctors are struck off for substandard treatment. But what are the facts?