Harold Fredrick Shipman

The British general practitioner
who might be the world's most prolific serial killer

Dr. Harold Shipman is another case that medicine dismisses as a "one-off," as though there were nothing to be learned from his example. Which is one reason why no real progress is made in making patients safe - the refusal to recognize the problems. What is not "one-off" about Dr. Harold Shipman is what enabled him to sin for so long undetected. There is a crime rate in medicine. It's not just murderers. It's also sex abuse and violence and smaller sins. We discover and discuss only the ones that so large and numerous that they no longer can be denied.

Dr. Harold Shipman, since he was a doctor, was the authority who certified the causes of deaths he had caused as being innocent, just as other physicians certify the success of their own procedures, sweeping poor outcomes or intentional injuries under the carpet. There was no effective check on the information that he recorded. That in itself is a lesson.

Medicine demands so much trust from the community that something must be done to equalize the power imbalance. More skepticism about them would be a start, especially on the part of the police and the boards who are supposed to watch them. And better systems for monitoring their work are needed.

This can never be accomplished by asking the care giving community to oversee itself. The patient community must have in place mechanisms that allow it to see for itself what is going on. The care giving community has a conflict of interest and, among other things, views care givers like him as "one-offs."

A problem that occurs everyday

Shipman cannot be dismissed as a "one-off," as a unique and bizarre occurrence. He is an example of how smaller crimes, like rape and assault, are committed with impunity in medicine everyday. And smaller, but sometimes also life-ruining, crimes other than that. What is unique about Dr. Harold Shipman is that he got caught. What is not unique is how easily he could do whatever he wanted to patients with impunity. That is too much power to give to anyone, especially a whole class of people. The system that allowed him to murder so many for so long allows many others to commit many more crimes everyday. Any patient safety discussion that does not begin with questions about how to enforce criminal law in medicine simply doesn't recognize the fundamental problems.

He was indicted for 218 murders. There are 62 more that he is believed to have committed. In spite of overwhelming evidence, he continued to declare his innocence. Given what is written elsewhere on this site about health workers, he very well may have believed that he was innocent.

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According to Aneez Esmail, M.D., Ph.D., in the New England Journal of Medicine, if one defines motive as the rational explanation for the decision to commit a crime, then Shipman's crimes were without motive.

He may have gotten pleasure from the power and control that killing gave him.

He is another criminal who selected victims so as to avoid discovery.

Shipman was respected by both his patients and fellow healthcare professionals and was a hugely popular doctor in his community.

Has anyone ever met a health worker who does not believe and declare that all the people he or she works with are the finest people and he or she is absolutely confident that none of them ever could be a problem?