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LETTERS: M E Jan Wise Negligence of medical experts: Quality control of medical experts is being considered BMJ 2005; 330: 1026-b [Full text]

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BMA paraphernalia

William G. Pickering   (3 May 2005)

BMA paraphernalia 3 May 2005
William G. Pickering, Doctor 7 Moor Place, Gosforth, Newcastle upon Tyne. NE3 4AL Send response to journal: Re: BMA paraphernalia	BMA paraphernalia The BMA medico-legal committee chairman MEJ Wise has produced an abridged version in the BMJ this week of his earlier rapid response [1,2]. Readers will have noticed, perhaps without surprise, that it is no less bureaucratic than his first offering [3]. Brevity has not lead to clarity. "Although some cases of evidence presented by those eminent in their field have later been discounted ..", he writes. The general population already know this. Their newspapers tell them. They know too that it was not patients or the law who made such doctors "eminent". It was British medicine which uncritically elevated them. It is by no means clear that Wise and the BMA understand this. It is essential that they do. How does he aim to curb the fanciful reveries of these eminencies before they cause more havoc? How are future "eminent" medical personnel to be deterred? Why is it left to the courts to "discount" them, while patients, in all ways, pay the price? Why has mainstream medicine remained self-interestedly mute during the decades that these "eminents" rose and rose unchecked? In the conundrum that is his final paragraph, and as if groping to legitimise his farrago of a letter, Wise remarks that 'colleagues should take care to … censure experts for inadequate conduct in the medical domain rather than not being at the forefront of the legal domain'. Whatever he means, how exactly should "colleagues" enact this "censure"? "Censure", we must remind him, does not happen within the defensive world of medicine. This is one reason for single elementary medical errors passing without remark (let alone their perpetrators being "censured") — which is a potent cause of serial disasters. Not unrelated are escalating medico-legal claims and costs. If Wise is intent upon the notion of "colleague censure", could he kindly spell out how it works?. Is this a BMA brainwave to counter the continuing unavailability of clinical accountability? [eg. 4,5,6,7]. Is Wise's "censure" the same as whistle-blowing? Those currently agonising over innumerable initiatives to improve medical ''quality", including the "eminent" re-patchers of "discounted" revalidation, would surely be interested to know more — lest they are again on the wrong track. As would tax-paying patients, who, whilst keen to be 'protected', have not the slightest inclination to go first to the doctor, and then to a solicitor. But in the absence of meaningful clinical accountability they have, on occasion, no choice. By the by, when Wise himself was "censured" [3], it is interesting that it changed his modus operandi apparently not one jot [2,1]. On the likely efficacy of the BMA's brainwave therefore, we rest our case. Regarding Wise's slogan of "Quality control", the BMA have plenty on their plate in that department with daily clinical medicine. Here is the region to tackle and deter nascent medico-legal cases. At source. William G. Pickering. 3.5.05 wgpi@hotmail.com References. 1. Wise MEJ. Negligence of medical experts. Quality control of medical experts is being considered. BMJ 2005;330:1026 (30 April). 2. Wise M E J. Experts & Quality Control http://bmj.com/cgi/eletters/329/7478/1353#88159, 6 Dec 2004 3. Pickering W G. Re: Experts & Quality Control http://bmj.com/cgi/eletters/329/7478/1353#88520, 9 Dec 2004 4. Pickering W G. Systematic clinical accountability is required. BMJ, Nov 2003; 327: 1109. 5. Pickering W G. Clinical accountability. http://bmj.com/cgi/eletters/330/7481/1#91742, 7 Jan 2005 6. Pickering W.G. An Independent Medical Inspectorate. In: Gladstone D, ed. Regulating doctors. London: Institute for the Study of Civil Society (CIVITAS), 2000: 47-63. ISBN 1-903 386-01 7. Pickering W G. Rudimentary medical errors. http://bmj.com/cgi/eletters/328/7454/1455#63653, 21 Jun 2004 Competing interests: None declared