Medical Discipline: The Professional Conduct Jurisdiction of the General Medical Council, 1858-1990 (review)

Russell G. Smith has done a magnificent job compiling and analyzing little-used data regarding the discipline of medical practitioners in the United Kingdom from 1858 to 1990. Smith, lecturer in the Department of Criminology at the University of Melbourne, has employed publicly available information about the professional-conduct activities of the General Medical Council, from its creation by Parliament in 1858, to 1990. The book contains not only sophisticated statistical analyses of cases falling during the period in question, but specific recommendations and conclusions for reform of the Council’s jurisdiction and procedures. The work, then, has value to lawyers, legislators, and policy planners as well as to historians and sociologists of medicine.

All of that having been said, it must be noted that this is, perhaps of necessity, an extraordinarily narrow and dry book. Doubtless there are many dramas lurking within the files of the General Medical Council and its thousands of cases—but that is for another kind of work in this important but little-examined field.

Smith analyzes the General Medical Council in terms of (a) the statutory and procedural development of its jurisdiction; (b) the aims, basis, and other aspects of its disciplinary proceedings; (c) its cases and decisions; (d) its sanctions (including the nature and use of particular sanctions); (e) restoration of practitioners to the register; and (f) suggestions for reform and future research. A theme running through the book is whether the General Medical Council has actually achieved the ends of justice in its operation since 1858. Justice in this context, for the author, comprises the values of legality, fairness, accountability, impartiality, effectiveness, efficiency, and openness. Smith concludes that “the overall impression of the jurisdiction is that those who operate it seek to act justly and are aware of the need to comply with the various aspects of justice under consideration. Where injustices and illegalities have occurred in the past, they have been, on the whole, promptly eradicated, although legislative changes have invariably been slow to appear” (p. 221).

For readers who are not lawyers, the most interesting sections of the book will probably be the chapters surveying particular cases and analyzing statistics to reveal patterns. These analyses are amply assisted by clear tables and graphs. As an example, types of case are compared as to the qualification of the accused practitioner in either England, Scotland, Ireland, or Wales, or India/Pakistan. These show that among practitioners who qualified in Scotland and Ireland, cases involving alcohol offenses occurred more than twice as often as any other kind of case. Those who qualified in England were accused of sexual offenses more often than practitioners who qualified elsewhere; those who qualified in India or Pakistan were most frequently accused of financial offenses. When accused practitioners are sorted by gender between 1859 and 1990, readers see that females were most often accused of unregistered practice or certification offenses; males, of alcohol and sexual offenses. Smith would have liked to do more specific case-by-case study, but Council transcripts and exhibits from individual cases are not available to researchers.

This is not only fine medical history, but fine legal history. As Willard Hurst of the University of Wisconsin has demonstrated in studies of legal sources from that state, close scrutiny of a narrow band of cases in a specific jurisdiction goes far toward explaining the real environment in which people have lived and practiced their professions. Russell Smith’s use of the Council’s materials ought to inspire similar studies of discipline authorities outside the United Kingdom.