Stethoscopes and lies

November 12, 1999

In an alarming study, many future doctors said they falsified patients' documents when under pressure. Duncan Campbell reports

Many future doctors and medical researchers say they are willing to invent information or documents concerning their patients. In research just reported at an Edinburgh conference on misconduct in biomedical research held at the Royal College of Physicians, a large minority of medical students said they were willing to record false patient information or even to forge other doctors' signatures on documents.

The conference was attended by dozens of Britain's leading doctors, including Sir Donald Irvine, president of the General Medical Council, and George Radda, chief executive of the Medical Research Council.

According to the research, carried out by Sarah Rennie, a doctor and researcher at Dundee University medical school, and medical lecturer Jay Crosby, 99 per cent of first-year medical students were not willing to falsify information about patients. But the views of more advanced students were different. More than half of the doctors-to-be in their fourth or fifth years of medical school said that they were willing to make up data, or that they were "not sure".

Overall, 31 per cent of 461 Dundee medical students questioned in a cohort study said that they would be prepared to record "nervous system examination normal" on a patient's record, when the truth was that they had not checked the patient's nervous system at all. Among fifth-year students, a higher number - 40 per cent - said they would do this.

Asked if they would consider forging another doctor's signature, 98 per cent of first-year students said no and none said yes. But more than a third of the medical students in their fifth year had dramatically different views: 58 per cent said no - but 38 per cent said yes, they would commit or indeed had committed such a forgery.

Only four out of ten students said that they ought to report misbehaviour or fraud to the authorities if they saw it happen. And three-quarters of the students who thought that they should report misconduct would not in practice be willing to take the risk of blowing the whistle on colleagues.

The medical students were also asked,

anonymously, if they would cheat or had cheated in exams, falsified patient information, plagiarised other people's work, forged signatures or committed up to ten other misdemeanours. Copying in exams was the only one almost uniformly rejected by students.

Richard Horton, editor of medical journal The Lancet, told the conference that his wife, a junior doctor, had just been asked by her colleagues at an English hospital to join them in inventing medical audit data about their patients because, as hard-pressed junior doctors, they feared that they did not have the time to do genuine work.

Dr Horton said he wished to publish Dr Rennie's work in The Lancet, a reaction echoed by two other leading medical journal editors.

Charles Forbes, Dundee University professor of medicine, said: "This is high-quality research. It's the first time that such a large number of students has been directly polled on these issues. It's a unique study. I'm pleased we did it."

He said there are plans to turn Dr Rennie's work into a longitudinal study of doctors and medical researchers as they proceed into their careers.

Professor Forbes added: "I don't think anyone could be happy about the results. All the universities are looking at the same kind of problems. Dundee is just the first to try to quantify what the problems are."

Also under investigation is the fact that new assessment methods being used in universities make cheating easier and safer.

Students now use computers to write reports for assessment all through their courses, instead of sitting a single, final examination. The improper use of computers and the internet can make copying, cheating and plagiarising simple to do and difficult to detect.

The past ten years have seen a growing incidence of research fraud, from the bottom to the top of the profession. In June 1995, London consultant obstetrician Malcolm Pearce was found guilty by the GMC of serious professional misconduct after fraudulently claiming that 191 women prone to miscarriage had been successfully treated with a hormone. Computer records had been doctored to support his fraud. One woman in his tests had been born in 1910 and was dead at the time of her supposed pregnancy.

In July 1997, John Anderton, former secretary of the Royal College of Physicians in Edinburgh, was struck off the medical register for conducting a 15-month sham drug trial. Anderton had been paid Pounds 42,000 to test Amlodipine, made by Pfizer. Working at the Western and General Hospital in Edinburgh, he forged consent forms for 17 patients, forced his assistant falsely to attest that she had witnessed the signatures, and then invented a string of medical results for tests that the patients had never had. After a Pfizer monitor spotted forged signatures, Anderton admitted the charges brought against him by the GMC.

Anderton and Pearce were two of more than 20 British doctors who have been struck off for fraud since 1988.

* THE NEED FOR A NATIONAL PANEL

The final statement from the Edinburgh Joint Consensus Conference on

Misconduct in Biomedical Research concluded that

a national panel should be established - with public representation - to provide advice and assistance on request.

The panel might:

Develop and promote models of good practice for local implementation Provide assistance with the investigation of alleged research misconduct

Collect, collate and publish information on incidents of research misconduct.

The conference called on the three Royal Colleges of Physicians and the Faculty of Pharmaceutical Medicine to convene at the earliest opportunity a meeting with the General Medical Council and appropriate partners to establish the remit of the national panel.

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