Trust Me writer Dan Sefton reveals why fake doctors might not be as bad as you'd think
The new medical thriller with Jodie Whittaker is alarmingly real – but incompetent doctors are a larger problem than impersonators
It’s not that hard to fake it as a doctor if you have some qualification, particularly if you’re a nurse or a pharmacist,” says Dan Sefton, the writer of Trust Me. And he should know – because when he’s not writing television dramas, Sefton is a practising doctor.
His thriller stars Jodie Whittaker as a nurse and single parent, unfairly suspended by a hospital trust, who steals the identity of a colleague and lands a job as a doctor at an Edinburgh hospital. “She’s an honest woman who does one dishonest thing,” says Sefton. But she soon finds her competence severely tested.
Sefton is the creator of The Good Karma Hospital for ITV. But he also works as a doctor in a busy accident and emergency department in Taunton. The father of three qualified in 1995, then left the profession for a time after his writing career took off – on shows such as Doctors and Born and Bred – before returning to work in A&E.
And his new drama presses on a particularly sensitive area for the medical profession. In July 2015, it was reported that Georgia-born Levon Mkhitarian had been able to pass himself off as a doctor for three and a half years at seven different NHS Trusts, treating thousands of patients in cancer, cardiology, surgery, transplant and A&E departments.
The 36-year-old arrived in the UK in 2007 with some medical qualifications, which enabled him to register with the General Medical Council, but he abandoned a training course that would have allowed him to work here legitimately. He still obtained work visas in 2010 and 2012 to work in the NHS, and was employed in senior roles in Taunton, Crewe, Oxford and Harrow before giving a false reference in a job application in 2013, and being struck off.
Undeterred, he then stole the identity of a GP in Kent, and forged documents that allowed him to apply for locum positions. He was only caught when the HR department at a hospital in Ashford tried to give him computer access privileges and discovered he was using a false identity.
As far back as 1996, a university study found 30 cases of bogus doctors practising medicine in the UK, including an unqualified pharmacist from Pakistan who was able to work as a GP in the UK, undetected for almost 30 years, after arriving here in 1961. He was only caught when a member of his family informed the authorities and he was jailed for five years.
Afghan asylum seeker Abdul Pirzada, 50, was jailed in 2012 after working as a locum GP in Birmingham, prescribing medication to patients, having invented a glittering medical career. And last year, 36-year-old Mitchell Morris was jailed for lying about qualifications that gained him the position of senior cardiac physiologist at the Heart of England Foundation Trust.
Sefton believes the problem may now be much bigger than we think. “I realised when I first started doing this show that you could probably be an impostor if you didn’t go out, didn’t have a relationship, didn’t have any friends, just did the job… probably no one would catch you.”
He also suggests that by targeting “the jobs nobody else wants to do”, such as night shifts in high-stress departments, the chances of a fake doctor being employed go up: “Get a half-competent doctor who looks good on paper and [employers] will bite your hand off.”
Sefton, who has also written for Casualty and Holby City, took inspiration from several famous impostors. They include Frank Abagnale Jr, who was portrayed by Leonardo DiCaprio in the 2002 film Catch Me If You Can – “There are stories that he went on to be a naval surgeon and did an appendectomy on a ship, did it really well, and the patient survived… he was a good doctor, people liked him.”
Then there’s the case of James Miranda Barry in the 19th century, who lived her entire professional life as a man so that she could practise medicine. Sefton says that an impostor would least likely be spotted in A&E or general practice – “If you are a generalist, then gaps in your knowledge are more explicable.”
The internet has made it easier to bluff about medicine, he notes. “I think doctors who don’t use Google are basically incompetent, because there’s no way that you can know everything, and if you don’t know you should look it up.” In Trust Me Jodie Whittaker’s character uses internet searches to hide her lack of training.
How quickly does Sefton think he would get a sense that a doctor was bluffing? “If somebody was pronouncing the medical terms wrong that would be it, bang, straight away – but competency as a doctor, absolutely not.”
But when he’s asked to spell out the dangers of fake doctors, Sefton’s answer is surprising. “I honestly think the dangers are minimal. You’ve probably got a better chance with an impostor who’s really motivated to do a good job than you have with an uninterested, lazy, arrogant, qualified doctor.”
Has he ever worked with a fake doctor himself, or suspected someone was faking it? “There was one in a hospital where I worked. He was pretty competent and was only found through an administrative mistake,” he says, before arguing that incompetent doctors are far more common.
“There have been some memorable people who were very bad doctors. There’s a period where everybody realises, ‘Oh my God, I don’t trust them.’ Often the nurses pick it up and the smart doctors will listen to the smart nurses and chase it up, but it’s a constant problem with people of varying competences in all sorts of medicine.”
One of the problems, he says, is that the medical hierarchy makes people afraid to challenge more senior colleagues. “As you get more experienced you get more bullish, but when you’re junior, if somebody senior is saying something you don’t believe, it’s very hard. There’s still that sense that somebody can be dodgy and you have to let it go… well, I don’t, but other people do.”
In the opening episode of Trust Me, one of the senior doctors describes the new crop of juniors as “potentially lethal”. Is that an accurate reflection? “It’s a bit of a joke but it’s based on truth: they used to say that August and September were the killing months, because that’s when the new doctors joined. There’s extra supervision now, but it’s still a real thing.”
The detail in the show is so exact that it would be hard to write if you weren’t a practising doctor, says Sefton. He even had Whittaker practise her cannula-fitting skills on a vein in his own arm. The dislocated ankle that Cath has to straighten out in episode one has been toned down a bit (“I saw a much worse one”), but the panic that Cath feels when she learns that victims from a motorway pile-up are on their way to A&E is real.
“It makes me tense to watch it,” Sefton admits. “We all have the same reaction. Something’s coming and it’s going to be bad. Am I going to be able to cope?” In life-or-death situations, seconds count.
“When it comes to airway problems, when people cannot breathe, you’ve got as long as it takes you to hold your breath before you need to do something. If there’s an obstructed airway coming in, my heart would be racing… I know in theory how to do a tracheotomy but could I do one if I was caught in the situation? Well, I’d give it a go…”
Trust Me is at 9pm on Tuesdays on BBC1