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  1. R Persaud
  1. Gresham Professor and Consultant Psychiatrist, Maudsley Hospital, Westways Clinic, 49 St James Road, Croydon CR9 2RR, UK;

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    The view of the cognitive behavioural therapist (the new dominant paradigm in psychiatry) is that it’s not what happens to you in life which leads to stress or upset—more it’s how you interpret what’s happened to you. Psychotherapists frequently employ a technique called “reframing” whereby a negative life event can be reconstrued so as to render it less threatening and upsetting. Some self help gurus from an American persuasion even take this approach to an extreme with the catch phrase “how can I make this problem more perfect”—in other words crisis often represents an opportunity—if you know how to get past the emotional turmoil, recover your composure, and seize the advantages which might conceivably lie among the wreckage.

    These sentiments may seem inappropriate when we think of the tragedy of Harold Shipman, but the huge losses may have been easier to bear if the correct lessons could have been learnt which would lead to an improvement in medical standards. Instead it doesn’t appear to most doctors that the reforms now being shovelled on to an already burdened profession off the back of Shipman, are likely to make any meaningful difference to clinical excellence. If anything they appear to be yet another tranche of bureaucracy solely designed to frustrate us.

    The issue isn’t so much the bare facts of the Shipman case (of which much remains uncertain), rather the key question is how the medical profession interprets the event and in particular how it attempts to influence public opinion and government. Sadly, as is all too usual today, the profession—which labours under an 18th century view of public relations—has passively allowed a sequence of events flowing from Shipman to drive the public agenda rather than making any attempt to be proactive.

    Modern medicine is supposed to be based on science; there appears so far nothing scientific about the way the key question has been approached in an attempt to understand how Harold Shipman came to be. We need to more robustly defend our profession and our methodology if we are to survive. But because we are an ancient profession, I fear that the government has already penned DNR [do not resuscitate] in our notes.