DOCTOR, WALSALL (FORMER PATIENT) (Hansard, 12 May 1965)

§ Mr. William Wells (Walsall, North)

I seek this opportunity to refer to a matter arising from a series of events in my constituency, and to draw attention to a point of some general importance in relation to the ethics of the medical profession, and the kind of service and behaviour which the public is entitled to look for from members of that profession.

This sequence of events started as long ago as 7th May of last year, when a doctor, to whom I shall refer as Dr. A, was driving in my constituency to see a patient on urgent call. At one point in his journey six ladies were crossing the road. He failed to observe them and knocked down one of them who 666 suffered a fractured pelvis and head injuries. As a consequence of that accident, on 10th August proceedings were taken in the magistrates' court, Dr. A. being prosecuted for driving without due care and attention. He was convicted, and fined £20. The witnesses for the prosecution included a Mrs. Smith, the wife of a well-known licensee in that part of my constituency called Bloxwich. She criticised the speed at which Dr. A was driving his car.

The next event was on 29th August, when Mrs. Smith received a notification from the local health executive council that she and her family were being removed from her doctor's panel; her doctor, to whom I shall refer as Dr. B, being a partner of Dr. A. Mrs. Smith asked the reason for this removal, and was told that the convicted doctor was her own doctor's partner and that he would not treat her or her family again.

It is quite plain that Mrs. Smith in giving the evidence she did was doing her duty as a member of the public who had witnessed a fairly serious road accident. The stand that Dr. B. is taking is, in effect, that he will not treat members of the public who do their duty in this way if it causes inconvenience to himself or to his partner.

This matter came to me, and on 5th September last I wrote to the then Parliamentary Secretary to the Ministry of Health outlining these facts. I concluded my letter by saying: It thus appears that not only this lady's own medical treatment, but that of her family, is to be prejudiced because she carried out her duty by giving evidence when called upon. I should be grateful if you would try to secure action that is taken to put this matter right. I had a reply on the 28th September, from Lord Lothian, then Parliamentary Secretary to the Ministry of Health. He said: I am afraid there is nothing I can do to help Mrs. Smith or her family to be reinstated on the doctor's list. It has always been a principle of the Health Service that a doctor should have a right to accept or refuse a patient as he wishes and have a patient taken off his list without needing to give any reason. The patient has, of course, a similar freedom of choice. I have no power to infringe this principle in an individual case, however unreasonable the action taken by one party may seem to the other. At this stage, I only comment that there must be a few who would wish to 667 interfere between the free choice of a doctor by a patient, or who would criticise the right of a doctor to discontinue services in certain circumstances. I do not think that the analogy of the position between doctor and patient and patient and doctor is quite complete. It is, after all, a great privilege to be allowed to practise a profession and the patient comes to the doctor because he or she needs the doctor's services, and because he or she has trust in a particular doctor. The doctor should, in turn, to some extent at least, take this as a compliment to his own skill and professional integrity.

I would have thought that it is a grave deviation from a proper standard of professional conduct to behave in the way that this particular doctor did. Certainly, in my own profession, a barrister who behaved in this way would incur grave censure and possibly severer penalties still. I do not think that it is unreasonable in this matter to look to doctors to have at least as high a standard as lawyers.

I raised this matter again after the change of Government. I had a letter from my right hon. Friend the Minister of Health in which he said: I have read the whole of this rather unhappy story with a good deal of sympathy, but I am afraid I do not see how I could change what has taken place. I have not the powers, nor, it seems to me, would any change really be to Mrs. Smith's advantage; it would, after all, be true that in Dr. A's absence obvious difficulties might come up. I agree with that to some extent. I certainly think that if Dr. A and Dr. B set themselves in this matter such low standards, it would not be to Mrs. Smith's advantage to continue on their list. I think it deplorable to accept that a doctor, even if he is aggrieved by evidence that has been given against him, would feel so strongly and so un-objective as not to give proper medical treatment when called upon to do so.

I have refrained from mentioning either of these doctors by name. I do not wish to spread any further bitterness. After all, since they are doctors in my own constituency, I suppose that if I myself were injured in a road accident, and I took action in this House beyond a certain point, they might leave 668 me to my fate and say, "That is the man who criticised my partner in the House. Let him bleed like the pig that he is." If one is to think in this way one comes to a deplorably low ethical standard.

This is a regrettable episode. I raise the matter in the House for two reasons. First, I want to ventilate the facts and use the House to publicise the matter, and perhaps discourage other doctors from behaving in this way, by giving publicity to the unfortunate repercussions this matter has had on public opinion. Public opinion in my constituency has been incensed in some respects by the behaviour of these doctors. Secondly, I wish to ask my hon. Friend whether his Department can take any steps to assist in this publicising process, to obtain a ruling from the appropriate professional bodies condemning the action by these doctors, and to seek to discourage other doctors in similar circumstances from taking a like regrettable course.

§ The Parliamentary Secretary to the Ministry of Health (Mr. Charles Loughlin)

I am grateful to my hon. and learned Friend the Member for Walsall, North (Mr. William Wells) for the moderate and restrained manner in which he has raised this case tonight. I know that it is a case which has given him and his constituent much anxiety over a period of some months and I welcome the opportunity given by this short debate to discuss it and, I hope, to put in perspective the issues of principle involved.

The facts of the case are straightforward and not, I think, in dispute. As my hon. and learned Friend has explained, in May, 1964, Mrs. Kathleen Smith of Bloxwich, Walsall, was called as prosecution witness against someone to whom my hon. and learned Friend has referred as Dr. A, a Walsall doctor who had been charged with driving without due care and attention. The doctor was convicted and fined £20 with costs. I do not think my hon. and learned Friend would want me to go any further into the details, because he himself has stated them much more fully than I intended to do.

669 On 29th August, 1964, Mrs. Smith was notified by the Walsall Executive Council, the body responsible for the administration of the local family doctor services, that she and her family were being removed from the National Health Service medical list of patients in the care of Dr. B, although they had all been his patients for some years. When Mrs. Smith asked the reason for this, she was told that Dr. A and Dr. B were partners and that Dr. A would not treat Mrs. Smith or any member of her family again. That was, as I understand it, the sequence of events.

My hon. and learned Friend's reaction was, understandably, that an injustice was being done to Mrs. Smith and her family. To quote the words of his letter to my predecessor as Parliamentary Secretary, the hon. Member for Essex, South-East (Mr. Braine): It thus appears that not only this lady's own medical treatment, but that of her family, is to be prejudiced because she carried out her elementary duty of giving evidence when called upon. My hon. and learned Friend made a similar point in writing more recently to my right hon. Friend the Minister when he said: I do not know whether it is strictly unethical, but it does seem to me wrong that a patient should be taken off a doctor's list and refused his services simply because she has done her duty as a citizen and given evidence when called by the police to the detriment of the doctor's partner. I should like to make it absolutely clear, as my right hon. Friend has done in writing to my hon. and learned Friend, that I have much sympathy with Mrs. Smith in the situation in which she found herself. In my view, she appears to have done nothing at all that was wrong in any way, or for which she needs to reproach herself or which could be taken as meriting any sort of punishment or retribution.

It is, however, most important for the House to understand the Minister's proper function in a case of this kind. It is not for him to apportion or to attempt to apportion credit or blame. More important, he has no power whatever to compel an unwilling doctor to keep on his list a patient or patients whom that doctor no longer wishes to treat. The only exception to this is where a patient has tried and failed to get on the list of 670 any doctor in the area. He is then assigned by the executive council to a doctor who has to accept him. But that is not the case with which we are dealing tonight.

The essental point is that, subject to this exception, under the National Health Service the doctor is free to refuse to accept or retain a patient on his list without giving any reason, just as the patient is free to choose or change his doctor without giving a reason of any kind. I think that hon. Members will agree that it is right that this mutual freedom of choice should exist and should continue and that an occasional case where that choice may appear to have been exercised somewhat harshly does not significantly detract from its advantages.

I have already explained that the Minister has no power to compel a doctor to keep a patient on his list except to ensure that the patient is not left without a doctor at all. It can be argued that he should assume such power, though I do not think that my hon. and learned Friend has gone as far as that tonight. I do not think that it would be right for the Minister to assume powers of that kind.

Let us for a moment consider what the effect might be of Dr. B being obliged to take the Smith family on his list again. I appreciate that my hon. and learned Friend quite rightly personalised circumstances of this kind and referred to what might happen in his own case. I would agree absolutely that we ought to have a situation in which where circumstances similar to those which we are discussing obtain it ought to be possible for individuals, whether patients or doctors, to treat matters of this kind in a purely objective fashion. What we have to deal with is not that which we would desire, but that which obtains, and I think that my hon. and learned Friend will accept that it is the unusual situation where we have two people of this kind in this particular relationship where we do not have complete objectivity.

Good will and confidence between patient and doctor are essential for successful treatment. Where these have been lost for any reason, whether it is the patient's fault—I want to make it perfectly clear that I am not arguing 671 that it is in any way the patient's fault in this case—or the doctor's, or is a simple matter of incompatibility, it is, surely, best for both parties that the relationship between them should come to an end and that the patient should transfer to another doctor.

There is no question but that good will and confidence have been lost between Dr. B and Mrs. Smith. It may be said that, while a proper doctor-patient relationship might now be impossible or, at least, difficult between Dr. A and Mrs. Smith, this was no reason for Dr. B to have her removed from his list, and still less for the whole family to be removed. I believe that such an argument would be mistaken. The essence of partnership practice is that the partners should see each other's patients whenever this is necessary to secure adequate time off duty for each doctor, or for other reasons. I think that my hon. and learned Friend will accept that without my going into any detail.

If Mrs. Smith remained on Dr. B's list, she might very well have to he treated by Dr. A sooner or later. As regards her family, some doctors would, I think, prefer to be responsible for the care of the whole family, and they would say that the condition of, for example, a child can be diagnosed and treated best by a doctor who knows the parents well and has their confidence. If Dr. B and Dr. A take that view, then, if Mrs. Smith was no longer to be treated by Dr. A, it would follow that her whole family should be transferred to another doctor, and I do not think that one could object to that consequence.

As I have said, I have a great deal of sympathy for Mrs. Smith in this case. She must feel that, with the conviction of Dr. A, we have clear evidence of her truthfulness as a witness, and that it is not right for a citizen who does his or her duty by giving evidence in a case of careless driving to be penalised in any way as a result. I can only urge her, through my hon. and learned Friend, not 672 to regard her transfer to another doctor as in any sense a punishment for her proper and public-spirited action. A doctor must, above all, have the confidence of his patients, and when, as in this case, he feels that he has lost it, the only thing to do is to hand the patient over to another doctor who will have this essential asset. As my hon. and learned Friend knows, the Smith family have been placed on the list of another local doctor, and, as far as I know, there is no question of their going without, or having gone without, necessary medical advice and attention.

I appreciate that, as a member of another profession, my hon. and learned Friend is bound to try to think of what would happen in similar circumstances if one of his colleagues were to be involved. But I must urge upon him—I think that he will accept it, on reflection—that the relationship between barrister and client, or even between solicitor and client, is by no means on a par with the relationship between doctor and patient. There is a continuity of relationship between doctor and patient which one seldom gets—at least, with an honest citizen—between, say, a client and a barrister, or solicitor.

We have not asked for a ruling, but what we have to recognise is that there is this continuity of relationship between doctor and patient and to try, so far as is humanly possible, to maintain the principle of freedom of choice for the patient. That is an essential point, but also, so long as we are able to ensure freedom of choice for the patient, it is equally important to have freedom of choice for the doctor as well.

I am glad that my hon. and learned Friend has raised this subject tonight. While I am sorry that I cannot be more helpful, I assure him that we have every sympathy with Mrs. Smith.