Medicine Interview Hot Topics: Dr Harold Shipman
Harold Shipman was Britain’s most prolific serial killer. A GP, he killed at least 250 of his patients over a 23 year period, before being convicted of murder at Preston crown court in January 2000. He killed himself in 2004. At this point he was serving fifteen life sentences.
He killed his first victim in March 1975; Eva Lyons was on the eve of her 71st birthday. In 1976, Shipman was convicted of obtaining pethidine (which has a similar effect to morphine) by forgery, in order to supply his own addiction. He received psychiatric and drug treatment in York, and became a GP again in Hyde in Greater Manchester. Shipman had not been removed from the GMC register when he was convicted of forgery, although he had to pay a significant fine.
He then went on to kill 71 patients at Donnebrook Practice, and the remainder at his own single GP surgery on Market Street.
By the late ‘90s, undertakers in the area became suspicious at the rate at which Shipman’s patients were dying. A neighbouring medical practice reported to the coroner that the death rate in his patients was ten times their own. The police investigation was botched, and didn’t check Shipman’s previous criminal record. Nor did it take the time to interview Shipman or any of his patients. Shipman had added false illnesses to his victims’ records, meaning that when the local health authority checked for inconsistencies between medical notes and death certificates, none were found. This left him free to kill another three of his patients prior to his final arrest in 1999.
Shipman’s undoing was his decision to forge the will of Kathleen Grundy, one of his victims and a former mayoress. He altered it to leave him everything, administered a lethal dose of morphine to her, and changed her will further to state that she should be cremated. However, she was buried, and her daughter suspected foul play. The police were able to exhume the body, finding morphine in her muscle tissues. Further victims were exhumed, compounding the evidence.
What failings were present and what should be learnt?
The shipman case illustrated to a terrifying degree failings in the healthcare system and policing. Without a doubt, Shipman’s final three victims could have been saved by an efficient police investigation into the other patients’ deaths.
There are broader problems that should be noted as well. By issuing certificates stating natural causes, Shipman was able to avoid detection or investigation by coroners. He was able to stockpile morphine easily. The GMC had been too focused on protecting doctors, rather than caring for patients - which is its primary task.
In light of the Shipman case, changes were advised to the Coronial service and death certification, as well as making it easier for families to report concerns about medical care to the coroner.
One must bear in mind that serial killing by a doctor is incredibly rare - if it happens again, it seems logical that whoever commits the crimes will seek to evade any new monitoring system put in place. This has been used as an argument to avoid constructing a process to detect doctors whose practice (or patients’ outcomes) significantly moves from the norm. However, it must be ensured that nothing like this can happen again - therefore increased monitoring, more complex death certification, and greater answerability to families and coroners are a small price to pay to avoid murder on such a scale.
Potential questions which may be asked in the interview
- What do you know about Harold Shipman?
- What does the Harold Shipman case tell us about oversight in the medical profession?
- What changes do you think may have been made, or should have been made, in light of the Shipman case?
- What measures are in place in the UK to keep doctors working professionally and ethically?
- How could you stop anything like the Harold Shipman case from happening again?
How to answer questions on Harold Shipman
If the Shipman case comes up at interview, you won’t be expected to have a huge knowledge of the minutiae of the case. But you will be expected to have reflected on the impact it had on the public’s trust in doctors, and on changes that should have been made after the case was unravelled. Think about trust, the doctor-patient relationship, and the ongoing personal development assessments and monitoring by the GMC that are part of a doctor’s life today.