JRSM >
Volume 99, Number 1 >
Pp. 1
[kamran.abbasi{at}rsm.ac.uk]
The last 2 years have been troublesome ones for paediatricians. The General Medical Council delivered verdicts against Roy Meadow and David Southall, the leading lights of child protection, and paediatricians began to wonder who would protect them if they raised concerns about child safety or gave evidence in court? These were also worrying omens for children who are at risk of injury or abuse but on whose behalf the medical profession finds it increasingly difficult to speak up. How did we come to this? What forces have cowed a profession that prides itself on improving the health, and consequently, the lives of the most vulnerable members of our society?
David Hall, former president of the Royal College of Paediatrics and Child Health offers a fascinating critique of the evolution of fabricated illness and how it has played out in the courts, including an explanation of Meadow's famous 1 in 73 million statistic (p. 6). Despite the GMC's decision to censure Meadow for using this information in court, paediatricians around the country are angered and dismayed that a possible failure of the legal system has been rebranded an error of medical expertise. Surely, argue many doctors and lawyers, it is for the courts to decide which argument is the most persuasive and which expert witness the most expert and believable? After all, very little that we advise our patients and others on can be said with absolute certainty—and that is especially true of statistics. Perhaps, then, Meadow's folly was to state his case with unflinching certainty, something the wisest statisticians would advise against. But was that folly enough to be struck off the medical register?
Child protection is not a problem for one or two individuals, it is a challenge that everyone concerned with child welfare must confront. This issue of the JRSM begins to spell out a possible future. ‘It is a bitter irony,’ writes Hall, ‘that among the many doctors who have been called before the General Medical Council are several who have contributed so much to our knowledge of child abuse.’ In response to the controversy, the Royal College of Paediatrics and Child Health has developed new training in child protection, with the aim that paediatricians ‘will no longer need to be pre-occupied with the risk of having their career abruptly interrupted or terminated by inappropriate management of complaints about their work’. However Hall's specialty emerges from this crisis, one important lesson for clinicians is that certainty in medicine is a dangerous concept—something to be dispensed sparingly, if at all.
Certainty of the value of health service reforms is a posture favoured by politicians. Are they right? Tim Wilson, Martin Roland and Chris Ham, all of whom have been involved with planning or researching the current reform agenda, describe how the future of general practice might look in England (p. 24). Meanwhile Richard Lewis and John Appleby analyse the future implications of the Government's new 18-week waiting time target for diagnosis and treatment (p. 10). Lord Kelvin—perhaps the most eminent scientist of his age—once predicted that X-rays would prove to be a hoax, neatly illustrating that all predictions of the future are an exercise in uncertainty.
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  F. Lockyer Futures uncertain. J R Soc Med, April 1, 2006; 99(4): 168 - 168. [Full Text] [PDF]
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