Tuesday 21 November 2017

Patricia Casey: Need to be vigilant in epidemic of Fake Doctors

Stock photo
Stock photo
Dr James Barry

Patricia Casey

In the current issue of the British Medical Journal there is a report from Germany of a man with schizophrenia posing as a psychiatrist in a German hospital for over a year until he was discovered in June.

The documents, which he forged himself, falsely indicated that he had qualified in medicine at Donetsk National University in Ukraine.

The organisation charged with checking the validity of doctors' certificates (similar to our Medical Council) issued him with a temporary medical licence valid until 2018, saying that a permanent licence would be issued pending the outcome of further investigation. In June, it found that he was not a doctor and he was arrested.

The man had been involved in another major fraud a decade ago. In that case, he forged documents indicating that he was a qualified elderly care nurse. He worked at several care homes for elderly people from 2006 until the fraud was discovered in 2011.

The case against him was repeatedly adjourned until he underwent treatment for his psychosis, by which time he was now working as a trainee "psychiatrist". He was, according to staff at the psychiatric hospital, not suspected of being a fraud and he had learned psychiatric jargon and some of the techniques during his own treatment.

Perhaps because the skills of the psychiatrist are clinical rather than technical, as in surgery, it may be regarded as easier to fake. But that is belied by history.

Take the case of Dr James Barry, a Victorian surgeon who saved numerous lives and was the first British doctor to perform a Caesarean. It was only following Barry's death, after 46 years of practising, that it was discovered he was actually a she.

Women were not allowed to become doctors and so Margaret Bulkley, a shopkeeper's daughter, assumed her uncle's identity and lived her life posing as a male doctor.

Christian Eberhard hoodwinked the German health service by claiming to have qualified at the University of Oxford, even though he had hand-written his certificate and misspelt doctor with a 'k'. Yet he was allowed to operate 190 times; and far from having any medical qualification, he was a banker.

Levon Mkhitarian came to the UK from Georgia in 2007. A few years later, he started training to work as a locum doctor but dropped out in the first year.

Undeterred, over the next few years he simply kept on working within the NHS, forging emails from the General Medical Council declaring he was fit to work. This forgery was discovered in 2013, and Mkhitarian was suspended and struck of the GMC's register altogether.

He then stole the identity of a real medic and obtained work at another NHS trust, where he worked in cancer, cardiology, surgery, transplant, and A&E. He created a fictitious CV, created fictitious utility bills, bank statements and letters. The deception continued for a further two years until in 2015, when at a hospital in Kent, the HR department tried to create an ID card for him and the system showed one had already been issued in that doctor's name with a completely different photo. He is now serving a six-year sentence.

In 1996 the Health Service Journal in Britain published a study from Bath University that identified more than 100 bogus doctors in the previous few years employed in the NHS. One worked for over 30 years as a GP but most worked in hospitals. That is hardly surprising since much of medicine as practised on the ground is learnt by observation, like an apprenticeship.

And newly qualified doctors are expected to be less knowledgeable than their more senior colleagues, so fakes can blend easily into such a culture.

The story of Mkhitarian has inspired Dr Dan Sefton, now a writer, to pen a new BBC psychological thriller Trust Me starring Jodie Whittaker as a nurse who is sacked for whistleblowing and steals the identity of her best friend, an A&E doctor. The four-part drama is currently running.

The motivation for such fraud is likely to be as disparate as the people who engage in fraudulent medicine.

They are likely to include narcissistic fantasies of grandiosity, the lure of power over the vulnerable, the thrill of deception and not getting caught, the social rewards of being a doctor, and the ability to exploit others financially or sexually. Some may be mentally ill like the German man just convicted.

To my knowledge we have not had any such case in Ireland, but perhaps we should be vigilant. Our Medical Council is notoriously stringent and thorough in their checks of all doctors applying for registration.

That protection, together with appropriate whistle-blower protection, is the best protection the Irish public has against the myriad of such cases that have arisen in Britain and elsewhere in recent years.

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