The medical "scandals" of the past few weeks will have made many people uneasy. For example, the recent General Medical Council in the UK hearing concerning a gynaecologist who left a series of suffering British patients in his wake has rightly caused the public to ask questions about the regulation of medical practice.
There is a danger, however, of tarring all practitioners with the same brush. There must be a recognition of the difference between a genuine mistake and deliberate malpractice.
Let me state at the outset that this column is not about defending the indefensible. Nor is it intended to take away from the awful experience of those patients whose diagnosis is changed months or even years after receiving initial test results. For the individual patient, medical mistakes are both devastating and life changing.
However, we must recognise the difference between fraudulent medicine, involving deliberate malpractice, and medical mistakes. The case of the retired pathologist, James Elwood, bears further examination in this context.
Dr Elwood provided locum services to both the North Western and Southern Health Boards during the 1990s. At the time, he was in his 70s, having retired from consultant practice in Britain. His main responsibility was the examination of biopsy specimens to determine the presence or absence of disease.
If we look beyond the headlines alleging misdiagnosis in hundreds of cases, a different picture emerges. Some 625 tests performed by the pathologist in Tralee were re-examined by a review group. A single case involved a reclassification of the type of cancer a patient had. In Letterkenny and Sligo, 11 out of 945 cases were questioned, but the minor changes noted did not require the alteration of treatment for the patients concerned.
Now, as Dr Elwood himself pointed out when he unreservedly apologised for any hurt he had caused, those figures actually illustrate that his competence was within the range expected of a pathologist. If we took the work of the most eminent pathologist in the country and had it scrutinised by peer review, it too would result in some changes.
The fundamental reason for this lies in the nature of medical tests. They do not represent absolute science. Many cancer investigations require the subjective examination of a patient's tissue under a microscope. Cancerous cells do not jump out at the pathologist. Often their appearance is only subtly different from normal cells. This is especially true of borderline cases.
It has often struck me that doctors need to do more to tell patients about "false positives" and "false negatives" in medicine. We have yet to invent a medical test which is 100 per cent accurate.
A useful test will have a low rate of false positives and false negatives. However, we do not have any tests which will never say a patient falsely has a disease. Nor can we guarantee not to reassure a patient who has an illness that he is in the clear. For all the advances of modern medicine, such perfection simply does not exist.
Rather than get carried away with lurid headlines suggesting medical malpractice, perhaps we should look for a different sort of "error" in medicine. It is important for consumers to remember that doctors are human; it should be presumed they make mistakes.
Profs James McCormick and Peter Skrabanek offer the following in the introduction to their book Follies and Fallacies in Medicine: "The kind of error which we are concerned with are errors of doctrine, systematic errors that are part of dogma and accepted truth. Our purpose is not to criticise medicine or those who practise it, but to advocate the need for criticism in medicine."
Such an approach might instigate a healthier debate than the cul de sac of blame we have seen to date. This quotation from Galileo by Bertold Brecht, comes to mind: "The chief aim of science is not to open a door to infinite wisdom but to set a limit on infinite error."
Cicely Saunders's name was spelled incorrectly in the interview with her on this page last week.
Contact Dr Houston at mhouston@irish-times.ie or leave messages on tel 01-6707711, ext 8511.