Doctors 'do not know best' in negligence cases

The Lord Chief Justice yesterday [18th January 2001] issued a stark warning to the medical profession that the courts would no longer apply a deferential "doctor knows best" doctrine in medical negligence cases.

Lord Woolf, the most senior judge in England and Wales, made it clear the courts had no sympathy with doctors' argument that "a compensation culture" is responsible for the huge bill for negligence run up by the National Health Service - a liability put at £2.4bn in its last set of accounts and still rising. Instead, he laid the blame firmly at the door of the medical profession.

He said the scale of the litigation showed the health service was "not giving sufficient priority to avoiding medical mishaps and treating patients justly when those mishaps occurred".

"It was clear to the courts that the hospitals and the medical professions could not be relied on to resolve justified complaints justly," Lord Woolf said, in a phrase which may return to haunt the embattled General Medical Council, the doctors' disciplinary body.

The medical profession's approach of fighting every negligence claim - resulting in "particularly bitter and often singularly unproductive" litigation - is just one of a series of factors identified by Lord Woof to explain why the courts have abandoned the "excessive deference" they showed to doctors in the past.

Lord Woof's attack on the health service's mishandling of the "disaster area" of medical litigation comes just days after Sir Donald Irvine, GMC president, warned doctors there were "deep-seated flaws in the culture and regulation" of the profession.

Judges are "not oblivious" to the recent "series of well-publicised scandals", Lord Woolf said. He cited the "deterioration in confidence [in doctors] by the public and judges alike" suggested by a 30 per cent rise in the annual level of complaints to the GMC.

Lord Woolf said he "could not help believing" that those involved in the scandals had "lost sight of the limits on their powers and authority. They acted as though they were able to take any action they thought desirable, irrespective of the views of others".

He supported the shift from the "doctor knows best" old approach to the more critical current one in which "it could be said that doctor knows best if he acts reasonably and sensibly and gets his facts right".

The speech will add to the gloom within the medical profession. Earlier this week, Sir Donald acknowledged that never before have doctors felt "so angry, undervalued and disillusioned".

But Sir Donald also accused doctors of "excessive paternalism, lack of respect for patients and their rights to make decisions about their care, and secrecy and complacency about poor practice".

"Financial Times" 18th January 2001