Nurses may be reluctant to challenge 'man in white coat': Hospital staff can put too much faith in a figure in a white coat who is carrying a stethoscope. Andrew Gliniecki reports

WHEN John Collee donned a white coat and stethoscope he discovered they had a powerful effect.

He could enter hospitals where his face was unknown and no one would dare to question his behaviour. He could freely examine patients and nurses would follow his commands.

In fact, John Collee is a fully trained doctor. But the ease with which he gained access to large, often impersonal hospitals as a locum completely unknown to regular staff inspired him to write A Paper Mask, a book which was made into a film two years ago.

In the film a hospital porter, played by Paul McGann, assumes the identity of a dead doctor and gets a job treating patients in a hospital casualty department. Far-fetched? Not as far-fetched as you might think, Dr Collee said.

During the early and mid-1980s he worked as a locum at hospitals throughout the country. 'It struck me how much my position was taken on trust - there is so much faith in a figure in a white coat holding a stethoscope.'

The bogus doctor's task was facilitated by the impersonal nature of some large hospitals. Doctors do not have to wear photo-identity cards. Nurses are so used to doctors coming on their wards from departments other than their own that they are not always suspicious of unfamiliar faces, he said.

Dr Collee added that the large and transient population of junior doctors was particularly vulnerable to incursion by frauds. 'At a more senior level, the chances of getting away with it are much slimmer. There are relatively small numbers within specialisms and everyone knows each other because they all go to the same conferences, compete for the same jobs and so on.'

He said the private sector was particular susceptible to imposters, because doctors in small private clinics were open to little scrutiny from other professionals.

Often fraudulent doctors are able to get away with the act because they adopt a very plausible bedside manner. 'But they lack the key ingredient of compassion which every good doctor has,' he said. 'They want what they regard as the glamour and respect which goes with the job, but they're not prepared to put in the necessary work to get the qualifications.

'Worse than that, they are prepared to put other people's lives at risk to get what they want.'

Dr Collee said that it would help if people in Britain were not so in awe of doctors. 'In America, patients are far less deferential. They ask their doctors much more penetrating questions.'

Caroline Richmond, founder of Healthwatch, which campaigns for good medical practice, said that bogus doctors broadly fell into three catagories: the 'Walter Mitty' type who fantasises about taking on the high-status mantle of a senior medical practitioner; the 'dirty old men' who pretend to be school doctors or gynaecologists; and the con-men who target wealthy patients with a view to stealing their money.

Impersonating doctors is a peculiarly male pastime. Ms Richmond has a dossier of 50 bogus doctor cases which are all men, one of whom was a transvestite.

Ms Richmond said: 'It would help enormously if hospital doctors' certificates were displayed in public areas such as outpatients clinic.' Photographs on certificates 'would be a good idea'.