When Satan Wears a Stethoscope

Kenneth V. Iserson, Demon Doctors: Physicians as Serial Killers. Tucson: Galen Press, Ltd., 2002. 441 pp. $28.95.

Demon Doctors: Physicians as Serial Killers is a compilation of 16 excruciatingly detailed stories and sidebars loosely related to physicians committing murder. Taken as a whole, Iserson's well-researched accounts set before the reader the ways in which physicians have become ideal stealth killing machines, either as agents of the state or as independent homicidal maniacs. Covering a smattering of cases from 1825 to the present, Iserson's book illustrates how the privileges accorded to the medical profession—such as intimate access to victims and specialized knowledge of and access to poisons, as well as opportunities to perform autopsies, provide expert testimony, sign death certificates, and hold the public trust—have been abused by physicians with fatal consequences.

The motives of Iserson's physician-killers fall into three general categories: greed, scientific curiosity, and run-of-the-mill sociopathic impulses. The victims varied. Some physicians killed their families and some killed strangers, but most seemed to have it in for colleagues and patients. Methods included the old "lace your colleague's sponge cake with dysentery" trick, and the "serve your husband ricin-laced dinners" routine, but several physician-killers preferred a quicker, more exacting method, such as death by iron maiden, disembowelment, or drug overdose.

It must be noted that a good many of the individuals featured in Demon Doctors: Physicians as Serial Killers were either not serial killers, not physicians, or not killers at all (see the 40-page chapter devoted to Joseph Stalin's use of physicians as scapegoats.) Thus, while Iserson successfully describes the lives of some very twisted individuals, his cases have little in common and his analysis is scant, yielding a book that falls short in both continuity and substance.

The one important message in Iserson's work is that even doctors can be lunatics, and surely this information is not shocking. What some might find shocking is the sheer number of patients physicians can murder without being caught, as illustrated by the recent cases of Dr. Michael Swango, who killed between 35 and 60 patients, and Dr. Harold Frederick Shipman (considered the most prolific serial killer in history), who killed between 300 and 1000.

The cases of "demon doctors" raise questions about the ability of modern medicine to protect patients from potentially dangerous physicians. While the physicians in Iserson's book were able to conceal their serial-killer personas from their colleagues, many were known to exhibit other behaviors that could jeopardize patient safety, such as narcotic addiction, theft, emotional imbalance, questionable medical decision making, and abnormally high patient mortality rates. The fact that they were also serial killers makes them just an extreme example of the problems inherent in allowing a traditionally monopolistic, insular, and powerful profession to police itself.

Although many of Iserson's physician-killers practiced decades ago, a variety of factors make it such that similarly dangerous physicians can still practice today. It is important, therefore, that patients not let their trust in physicians compromise their ability to think instinctually and critically. Shipman's patient-victims numbly complied with advice they recognized as unusual, such as the doctor's request that they return to their homes, leave their front doors unlocked, and wait alone in their bedroom for his visit. As a result of their compliance, when the community learned of Shipman's arrest they assumed the good doctor was performing "mercy killings" for the suffering elderly.

With respect to the professional community, physicians have traditionally demonstrated a reluctance to report one another to authorities such as hospital management, licensing boards, or the police (Stewart 1999). While this remains a problem, today's culture of medicine is more amenable to reporting than ever before. Hospital concerns about liability and medical error have made anonymous reporting mechanisms more commonplace and identifiable physician-informers are insulated from liability if the offending physician...