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Anger test
What do you do when you're mad?

[03/22/00]

Getting mad
A new study shows women can keep anger in and still be OK.
By Amy Standen
[03/22/00]

Column
Mike Nichols, what planet are you from?
In his latest dissection of the gender gap, the director of the great "Carnal Knowledge" trades earnest sexual consideration for a cheap, vibrating sight gag.
By Virginia Vitzthum
[03/21/00]

Stress
Act more like a zebra and it won't kill you.
By Robert Burton, M.D.
[03/20/00]

Urge
The voices in my head
They've been narrating my sexual fantasies and calling me names since I was 9, and that's ... OK.
By Cary Tennis
[03/18/00]

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Shipman's preferred victims were old and female. His chosen method was diamorphine, injected under the pretext of curing them of whatever it was they were suffering from, which quickly brought collapse and death. He watched them die, and never undid one button of their clothing.

As the judge told Shipman when he imposed 15 life sentences (the death penalty has been abolished in Britain), "I have little doubt that each of your victims smiled and thanked you as she submitted to your deadly ministrations. None of your victims realized that yours was not a healing touch. None of them knew that you, in truth, brought them death -- death which was disguised as the caring attention of a good doctor."

The effects of Shipman's exposure will be far-reaching. At 30, he had been fined $1,000 for illegally procuring the drug pethidine to feed his own addiction. But due to lax regulations that are still in force, he was still able to get a senior post.

Only now is the General Medical Council revising the rules that let Shipman go on practicing. But any system to monitor the performance of doctors will take years to set up, warns RCS president Barry Jackson. It turned out that the General Medical Council had no powers to suspend Shipman while he was being investigated by police.

There has also been a widespread demand for statistical monitoring of every doctor's patient list for unusually high death rates. But amid the clamor for closer inspection, there have been words of caution. A group of doctors wrote to the British Medical Journal on Feb. 19, warning that even 30-40 excess deaths a year would not be detected as statistically exceptional. They wrote: "Shipman's practice list of 3,600 would allow 18 deaths a year above the average to pass as unremarkable, which is more than the 15 murders over three years he is convicted of, and also more than the high estimate of 175 murders over more than a decade."

One of the writers, Dr. Stephen Frankel, added: "The best protection against lethal doctors is to strengthen the avenues for patients, relatives, other doctors, pharmacists, coroners and undertakers to inform about aberrant practices."

But the fact is that a good five months before Shipman was arrested the police were warned by local funeral parlors and fellow doctors that a disproportionately high number of his patients were dying. They launched a low-profile investigation, but could not find any evidence of wrongdoing. Three more patients were to die before he was stopped. "The records looked all right," said Detective Superintendent Bernard Postles, "but we now know that was because he was altering them."

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