Debashis Singh interviews medicolegal adviser Peter Schütte

I waited patiently in the lobby of the Medical Defence Union building--just a gallstone's throw away from Harley Street--riveted by the details the receptionist was giving over the telephone about her relationship. I was torn away to meet Peter Schütte, a medicolegal adviser for the union, whose talk on how doctors should handle the media was still at the forefront of my mind. Among other things I learnt that it is best not to hide under a potato sack when entering and exiting the court--apparently it looks suspicious--and to face the media with one's best profile while avoiding winking or maniacal smiles.

 

Dr Schütte, a former general practitioner (THE MDU)

"I am a specialist in legal and ethical aspects of medicine," Dr Schütte began. "So when someone has a problem s/he will ring up, and I am one of about 20 or so who will answer the telephone. The problems we face are varied. It may be a general practitioner inquiring whether a divorced father of a five year old boy has the right to see his son's notes if the child is living with his mother. Obviously, a general practitioner in that position needs expert advice to get in right, in order to avoid being accused of breach of confidentiality. Or I could be woken by a consultant in accident and emergency, wanting to know if it would be an assault if he held down and gave life saving treatment to a man aged 23 years who has taken an overdose of paracetamol and refused to give consent for the administration of acetylcysteine."

I wondered how one is groomed into being able to give advice to a daily barrage of legal and ethical dilemmas. Dr Schütte insists that his career in legal medicine was unplanned. Those who plan their careers often become lawyers but have a medical background or act as expert witnesses, for which extensive clinical experience is essential. In Dr Schütte's case, it was after nearly a decade of general practice that he made the transition into legal medicine after seeing an advert in the BMJ. "I didn't leave medicine because I disliked it, in fact I loved it. I got a real kick out of seeing the continuity of care and not just treating episodes of illness, but being involved in the patterns in people's lives and the wider aspects of being a human being. The reason I left medicine was not for anything negative, but rather to take up the challenge of something new."

An important aspect of his job is reassuring doctors after a complaint has been made against them. "Doctors naturally get very anxious and feel that 'I am no good; I am going to give up medicine.' That's a very common reaction." They have to understand that it [the complaint] is usually not motivated by malice. They [the patients] have a genuine concern that needs to be addressed, and if you have journalists asking questions, they have a legitimate interest in it, and, once again, they are not being malicious. Once you start getting questions fired at you from all angles, it is easy to get paranoid about things. If you are a doctor and have spent much of your life working very hard, putting a lot of effort in to helping people, it is very hurtful if something goes wrong and people start to criticise you, and I think that doctors, more than most professionals, find this very difficult to cope with. It is very much part of my job just talking doctors through what's happening to them. Just the process of talking through often solves a lot of their concerns."

Once a complaint has been made Dr Schütte tries to ensure that the doctor responds to the complaint in such a way such that matters are not made worse. "One reason why as a doctor you is may feel that the whole system is against you is when you can pick up a newspaper and see all sorts of allegations loaded against you, but because you are bound by confidentiality you cannot respond ... even to admit that the patient who is making the complaint is on your list is a breach of confidentiality ... it is very frustrating."

In a climate of "trial by tabloid," when the press is inevitably going to report the story from a patient's perspective, doctors are in a vulnerable position. Cases involving bereavement are notoriously difficult. "Relatives get so traumatised, and they are so upset, that rational thought suffers and they can be extremely difficult. On the one hand, you can feels desperately sorry for these people; on the other hand, you get frustrated, because of the gloss they are putting on it [the situation]. Their perception of it [the situation] can be so wide of what actually happened, but you have this terrible difficulty in having to explain things because whatever you say is not accepted because you are the bad guy. This is where the skill of communication comes in. Those doctors with the skill of communication are the ones who rarely have claims made against them."

When I asked Dr Schütte what the worst part of his job was, he answered without hesitation: "The realisation that a doctor has told me lie. That is always such a disappointment. The medical profession is a very honorable profession, and by and large people are very honest. When you come across a doctor who has lied that is always so disappointing; it always leaves a bad taste in my mouth."

Throughout the interview I thought that Dr Schütte projected a strange mixture of sad longing for his previous incarnation as a general practitioner together with great excitement about his current job. "In general practice you are not at the cutting edge. It doesn't have the same intellectual stimulation that this job has. There are no textbooks or journals I can turn to because it has not got into the journals yet." And with that it is time for me to leave. As I move through the lobby a smile spreads over my face as I realise that the receptionist is still talking to her friend.