Impersonating a doctor - a losing game

A fake doctor can go far with a good bedside manner and by relying on colleagues and the Internet

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By Anna-Stina Nykänen
     
      The recent revelation that a man with no formal medical training had worked as a doctor makes the lay person wonder how it is possible to get a position as a doctor, and to work at it successfully. Doctors, meanwhile, wonder why anyone would be crazy enough to try something like that.
      “When I went to treat a patient for the first time, I was terribly nervous. I was frightened by such a great responsibility”, says Samuli Saarni, of the Physicians’ Ethical Forum. Saarni was one of the speakers at the seminar on medical ethics held at the recent Doctor’s Convention in Helsinki.
      The most blatant case of impersonation involved Mika Jokinen, a 23-year-old man who worked as a doctor for more than a year in Karkkila and Karjaa on the basis of a mere high school education. Saarni manages to find something positive stemming from the publicity that the case generated: apparently beginners are given so little responsibility and so much guidance nowadays that no serious damage occurs. Jokinen dealt with the easy cases.
      “We have gone in the right direction, if he was supervised closely."
     
However, the tendency in Finland has been to be very trusting, to a degree that even surprises the doctors themselves. Most insist on anonymity before discussing the matter.
     If someone claims to be a doctor, the tendency is to believe them.
     “The membership card of the Finnish Medical Association does not even have a photograph. Perhaps there should be a photo-ID like the police have. After all, doctors have considerable powers, and an obligation to act if there is a car accident, for instance”, says one hospital physician.
     
In medical circles it is not customary to call a doctor’s previous workplaces, says one experienced doctor at a Finnish health centre.
      “Nobody has asked after me when I have changed jobs in Finland. When I went to Norway, they checked up on what kind of a person I am, and how I function in a working community.”
      The health centre physician is amazed that the fake doctor managed to cope with everyday work without drawing attention to himself.
      “Patients give feedback about a doctor very easily, but again we can see the automatic interaction: patients do not complain about poor medical treatment, but they do complain about being treated poorly as a person.
     
Confidence is not based on professional jargon, or the listing of erudite terminology, the hospital doctor says.
      “I myself am such a baby face, that I sometimes wonder if the patient believes me, and if I know how to act convincingly enough. One would need an amazing poker face and a big ego to dare take on this job without training.”
     
Uncertainty is part of the medical profession, especially in the early stages. It is not rare for a doctor to ask for advice, or check on the Internet for information.
      Finnish doctors have access to the Terveysportti website, they can check on the symptoms of the mumps, for instance, and on how to interpret the results of a pap smear. Doctors also have a book on clinical procedures, where they can check on how to remove a fingernail, and where to inject the local anaesthetic.
      “I remember myself the first times that I had to inject cortisone into an ankle or wrist, I went to another room to get the cortisone, and checked in a book exactly how the procedure was done”, the health centre doctor says.
     
“What about stitching a wound on someone’s brow?
      “A young doctor can tell an older colleague that he or she has not performed this procedure before, and ask of they could do it together. This is quite normal. Others ask plenty of questions, and are uncertain. Some just soldier on. From others it is apparent that the person is a bit on the clumsy side, but people like that might be more into research.”
      Experience is needed to learn skills, and not everything needs to be remembered.
      “But you can’t always check on the Internet all the time, it would take an awful lot of time”, says the health centre doctor.
     
Work at hospital wards is a team effort in any case. At health centres, the colleagues do not know what is happening inside the other consultation rooms. However, nurses end up asking doctors for advice in different situations. There are discussions even during coffee breaks, and it is not always possible to go on line.
      “At our clinic, we had a trainee who would always eat alone in his room. Not everyone is into the coffee table culture. That is a big shortcoming”, the health centre doctor says.
     
Is it a problem with the system, or with the attitude, which leads to the discovery of fakes among both nurses and doctors? With a shortage of doctors, people are happy to get anyone, and it never occurs to anyone to raise doubts about their credentials.
      The current trend is to set up bigger and bigger units. Colleagues are not necessarily up to speed on each other’s doings. The working community is splintered, as temp doctors can have different rules and different working hours, depending on the employer. Supervision is left in the hands of the head physician, the doctors explain.
     
In some places the same doctor might not meet a patient more than once; in a large unit, the patient ends up with a different doctor each time.
     Samuli Saarni would prefer long patient-doctor relationships. Municipal doctors and patients used to know each other. In those days doctors would operate in a manner similar to private entrepreneurs. This is still the case in most European countries and the Nordic region.
      However, the health centre doctor, who has worked in Norway, does not like that model. If a doctor is not a good one, the patient usually has no choice.
      Politicians, not doctors, are the ones to decide the direction to be taken, and every system has its drawbacks.
      A fake veterinarian in Kokkola was caught very soon: he could not cover up by talking pleasantly to the patients.
     
Helsingin Sanomat / First published in print 17.1.2010


Previously in HS International Edition:
  Doctors and medical students often hired at health care centres without proper job interviews (12.1.2010)
  Phony doctor hurts credibility of Karkkila health services (11.1.2010)
  Minister and Finnish Medical Association amazed at success of ruse (11.1.2010)

ANNA-STINA NYKÄNEN / Helsingin Sanomat
anna-stina.nykanen@hs.fi