The Kerr/Haslam Inquiry and its recommendations is the common theme that draws together this complex and important book. It is regrettable that despite the centrality of the Inquiry to the trust between healthcare professionals and patients, the publication of its outcome caused barely a ripple in the wider public domain. I wonder whether this lack of immediacy in the general public was matched by a similar lack of concern in the healthcare professions. And it would be interesting to know how many current practitioners and trainees actually know who Kerr and Haslam are.
The strength of this book is that it casts its net much wider than the gross misconduct of two psychiatrists. Relating directly to the Inquiry itself, the questions raised are less about what caused these two members of our profession to behave in a criminal and deeply offensive way, but how, despite the repeated complaints of their victims over many years, the health services effectively looked the other way. The Royal College of Psychiatrists, alongside the General Medical Council and other Royal Colleges (medical, nursing and allied professions) have been responding to this and other less sensational cases by developing a host of guidance on boundaries between healthcare professionals and patients and the potential for breaching these. The upside is that the training of students in addressing the ethical boundary dilemmas faced by healthcare professionals has never been stronger. The downside is that, taking Baroness Onora O’Neill’s seminal views on trust in public services into account, the resulting ‘tick-box’ culture perversely encourages what she terms ‘gaming the system’.
This book clearly maps the territory in the complex areas of boundaries between patient and professional (all regulated healthcare professions, not just doctors). Experts are drawn in from general practice, psychotherapy, sexual therapies and nursing; obstetrics and gynaecology; as well as teachers, ethicists, medical managers and healthcare regulators.
If my reading of the facts is correct, it would seem that interventions and regulation will have only a limited impact on the (quite rare) wily predator in preventing a serious boundary violation, but should obviate the potential for further violations by that person by bringing the offence quickly (and often painfully) to the attention of managers and regulators. However, the book contains important guidance on the prevention of boundary violations that vulnerable doctors can blunder into, perhaps due to a sometimes toxic combination of overenthusiasm and naiveté. As with any multi-authored publication the styles can vary, and inevitably what is presented is a book that should be dipped into rather than read in a single sitting.
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