Ensuring quality in primary care

When general practitioner David Lambert saw the 40 year old woman, accompanied by her friend, at his practice in Peel, Ontario, it seemed like just another consultation. What he didn’t know was that it was being videoed by the two women, who were private investigators sent in to pose as patients by the College of Physicians and Surgeons of Ontario.

Dr Lambert had lost his licence to practise in 2002 after a finding that he had sexually abused three women patients, and when it was reinstated in 2009 conditions were attached. He was not allowed to treat women or minors, to provide any cosmetic treatment, or to peddle his cosmetic products. The video showed him doing all three, and further charges followed.

The case is not the first in which the college has used “mystery patients,” although the tactic is not one to which it often resorts. UK doctors’ regulators don’t use such undercover approaches, but television viewers saw a similar operation in action last month when Channel 4’s Dispatches secretly filmed encounters between actors and doctors who had had conditions placed on their licences to practise by the General Medical Council, the UK regulator.

The programme, “Can you trust your doctor?” showed GPs ignoring “red flags” that should have alerted them to possible serious conditions that needed investigation (Dispatches, Channel 4, 3 Oct 2011). One advised a man who reported blood in his stools, a possible sign of bowel cancer, to “try to have plenty of vegetables and fruit—get yourself some mangoes.”

The most extensive review of quality across general practice in England in recent times, an 18 month independent inquiry commissioned by the King’s Fund published last March, …