In their book Doctors and Their Crimes: Hiding Behind the White Coat, experienced general practitioners Baroness Clare Gerada and Zaid Al-Najjar examine international cases involving medical malpractice, fraud, manslaughter, sexual misconduct and murder. They argue that institutional failures can allow criminal practitioners to escape detection, sometimes for decades.
They: 'Fear is the weapon so effectively wielded by those discussed in this book, and it is a culture of fear in healthcare that we must work to dismantle. Understanding the nature of these criminal acts helps us better support victims and improve systems for detecting and reporting misconduct.'
Between 1970 and 2006, 90 healthcare workers across 20 countries were prosecuted as serial killers, with links to 2,113 suspicious deaths, according to figures cited in the book.
The cases reveal recurring warning signs, including complaints, unusual behaviour and poor clinical outcomes that were allegedly overlooked or minimised. Some doctors were able to move between hospitals and regions, leaving behind positive references from employers who wanted them to leave.
The authors note that fewer than 0.5% of UK doctors have criminal convictions, compared with roughly 16% of the general population. However, they argue that crimes committed by medical professionals can have particularly devastating consequences because of the trust placed in them and their access to patients.
Gerada explains: 'Hierarchical and paternalistic systems mean that challenging a senior colleague might be seen as career suicide. Silence, driven by fear, loyalty, or learned helplessness, can sustain harm over many years.'
She also warns that nurses who raise concerns can be ignored, with gender imbalance adding to existing differences in professional status.
The book examines notorious cases including Harold Shipman, who murdered an estimated 215 patients, and American doctor Michael Swango, who poisoned patients and colleagues across multiple hospitals. The authors argue that both cases exposed weaknesses in oversight and a reluctance to challenge medical authority.
Research has found that only two-thirds of doctors who knew directly of an impaired or incompetent colleague reported their concerns, while nearly 12% cited fear of retaliation or a belief that nothing would happen.
The authors do acknowledge that some safeguards have improved matters. Following the Shipman case, for example, the UK strengthened systems for monitoring controlled drugs and investigating deaths.
Electronic records can also make it easier to identify unusual prescribing patterns, while whistleblowing policies and Freedom to Speak Up Guardians in England provide routes for staff to raise concerns.
On the other hand, new risks are presenting themseves. The growth of telemedicine has created new opportunities for inappropriate prescribing or exploitation, while international healthcare systems can make it easier for rogue practitioners to move between jurisdictions.
The authors argue that stronger rules alone will not prevent every case. They call for healthcare organisations to foster accountability, transparency and a willingness to listen to patients and staff.
'Preventing such cases is not solely about perfecting control measures, as criminal masterminds will almost always find ways to bypass them,' they suggest. Instead, they say, patients should be better informed about warning signs and feel confident raising concerns.
The challenge, they conclude, is to preserve the trust and independence essential to good medical care while ensuring that those who abuse their position are identified before more patients are harmed.
