I have just participated in a medicolegal exchange whose outcome was thoroughly unsatisfactory. The questions of negligence and causation were not publicly debated, and the decision was not based on evidence but reflected emotional issues and everyone's desire to stay out of court.

Medical negligence absorbs victims—patients and doctors—and disgorges them years later, often damaged and disgruntled, while its functionaries benefit. Despite the move towards closer regulation of clinical practice, medical negligence remains firmly in the dark ages that existed before the Kennedy report and the Bristol debacle. It is mostly secretive, unaccountable, and unregulated by audit governance or revalidation. Scant interest has been shown in it by our governing bodies, the royal colleges, the General Medical Council, or organisations involved in patients' safety.

The central players are the expert witnesses. The public assumes that they are in the forefront of their specialty, giving up to date, balanced opinions that are based on their own practice—honed by continuing …