There are few professionals we trust more than doctors. We put our lives in their hands. And when a story breaks of a doctor abusing that trust, the shock is profound. It raises questions not only about malpractice or institutional failure, but about human nature. What motivated Ian Paterson to carry out unnecessary, often botched operations on potentially thousands of patients?
Bureaucratic failure is, once again, the context to tragedy.
Readers may recall the case of GP Harold Shipman who was convicted of murdering elderly people in his care. The story was so bewildering that some, at first, wondered if he was practising euthanasia. But Shipman attempted to steal an inheritance; and while some victims were approaching the end of their lives, others were in good health. Shipman got away with his crimes for so long in part because he could appear pleasant, even kind.
Paterson has been described by his patients as “charming”. He persuaded one woman who had benign warts that the lumps were precancerous and performed a mastectomy that left her looking, in her words, as if she had been “in a car crash.” His surgical technique, called “cleavage sparing”, breached national guidelines, leaving behind tissue that increased the risk of cancer recurring. It was discovered that, over two years, at least 1,079 women underwent this dangerous treatment.
Why wasn’t he stopped earlier? He didn’t only abuse private patients: Paterson was employed by an NHS trust. He was repeatedly asked to stop using his procedure and yet continued to do so. A 2013 report by Sir Ian Kennedy detailed a recognisable list of failures: a culture of “weak and indecisive leadership... secrecy and containment” that meant the Heart of England Trust let its patients down. Sadly, it is all too reminiscent of the horror stories that emerged from the Stafford Hospital scandal. Bureaucratic failure is, once again, the context to tragedy.
Paterson was able to claim extra money for private procedures, implying a profit motive – but when a criminal operates on this scale and with this degree of depravity, it is understandable that his victims have branded him “psychotic”. He cut into the breast of one woman 27 times, in areas where there was no medical necessity at all. Such cruelty is almost beyond understanding. The health service must take the steps necessary to reduce the likelihood of it happening again.