Has publication of the Shipman report finally exorcised the evil spirit from the professional persona?

It is possible that at the beginning of his career Shipman was, in audit terms, no different from his peers. On qualifying, he would have been expected to survive with little support and encouragement during excessively long shifts.

How and why we treat the brightest of our generations in this way is sometimes beyond comprehension. But like some of his peers he may have been adversely affected by his experiences.

It would not have been unique for him to have felt humiliated and ashamed when his seniors admonished incomplete knowledge.

It would not have been far beyond the norm for the young doctor to trivialise some patients' sufferings and pain, and hide his professional fears and disappointments behind a compensating wall of aloofness and superiority.

But, perhaps like others who have also achieved recent notoriety, he willingly and effortlessly soaked in enduring attitudes or arrogance and selfimportance, and developed an irrepressible ability to defend his hierarchical status when challenged.

Is it here, in the conflicts of the early years of practice, where the darkness begins for some?

Shipman may have begun to nurture a growing resentment as he struggled with the mundane, imprecise and frustrating aspects of general practice that were not taught in medical school.

The Shipman report compels thousands of ordinary, trusting people to stare into the uncertainties of the past rather than look forward into their future.

Will they look unjustly and suspiciously towards the actions and decisions of the many thousands of GPs who genuinely and honestly endeavour to maintain our health and well-being?

Surely action concerning GPs' early clinical experiences, their high rates of suicide, alcoholism, drug abuse and divorce, must now go beyond the altruistic soundbites uttered so often by their professional leaders and employers.

Dr Paul S McDonald Senior lecturer (research) University College Worcester