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FEATURE: Graeme Catto Will we be getting good doctors and safer patients? BMJ 2007; 334: 450 [Full text]

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Regulation is not accountability.

William G Pickering   (5 March 2007)

Regulation is not accountability. 5 March 2007
William G Pickering, Doctor Newcastle upon Tyne. NE3 4AL Send response to journal: Re: Regulation is not accountability.	Regulation is not accountability. One of the four main functions of the GMC, President Catto avows, is “dealing effectively and fairly with concerns about individual doctors” [1]. How does he know who they are? Is the GMC to continue to rely for intelligence on the press and the law, and so always be behind the game? All sorts of doctors make clinical errors, daily and nationwide (ask any grandmother or neighbour). It would be terribly misleading to hint that most episodes of bad medicine are practiced by a few “individuals”, and that they are discernable by what Catto has called “MOT tests for doctors” – an analogy and mind-set for which he was brought smartly to book [2,3]. After all, some “individuals causing concern” are medical professors. Reasonably competent car drivers or those making annual income tax returns can make basic errors and, if noticed, are apprehended and incur a penalty. There is a mechanism to ensure this. By no means all are inveterate bad drivers or crooks. But, irrespective of their “MOT”, or their rank, or a previously blemishless record, their unequivocal identification is thought to deter them and others from repeating similar errors. There is still no such mechanism in medicine [4]. Were there a chance that single errors could be promptly picked up, “individuals causing concern” would, like dangerous drivers and fraudulent tax evaders, become evident sooner rather than later. As importantly, from a nationwide quality point of view, the rest (tens of thousands of doctors) would be given pause for evaluative thought. All know they are capable of making episodic basic errors. True, if there is no certainty these will pass unnoticed or unpenalised, as hitherto, any accountability device may perversely be seen by some as an ‘unprofessional’ pill. True, it may be initially injurious to their hubris. But until swallowed the endemic patchy practice defined by public inquiries and the press is likely to continue unabated. Medical students and junior doctors, who can fail examinations if they make one rudimentary clinical blunder, will understand all this very well. As will lay persons and politicians. Provided, that is, they are not brain-washed by medico-politicians into thinking trumpeted regulation plans are synonymous with meaningful accountability. One wonders if the reluctance to embrace this issue for so long is to keep lawyers out of the consulting rooms and theatres. More errors will be made manifest upon which they would voraciously feed. Yet the same accountability is a potent stimulus to avoid rudimentary clinical errors and they will become fewer. Would making motorists non-accountable increase or decrease road accidents? Does being able to drive through clinical red lights with impunity make medicine less safe or safer? William G Pickering. 5.3.07 wgpi@hotmail.com References: 1. Catto G. Will we be getting good doctors and safer patients? BMJ, Mar 2007; 334: 450 ; doi:10.1136/bmj.39136.510949.AD 2. Shipman Inquiry. Chairman Dame Janet Smith. 2004. Fifth Report. Vol 3. Para 26.187. Page 1086. 3. Pickering W.G. GMC pre-emptively wash their hands of responsibility for poor practice and clinical errors. http://bmj.com/cgi/eletters/330/7481/1#100104 11 Mar 2005 4. Pickering W.G. An independent medical inspectorate. In: Gladstone D, ed. Regulating doctors. London: Institute for the Study of Civil Society, 2000: 47-63. ISBN 1-903 386-01. [http://www.civitas.org.uk/pdf/cs01.pdf] Competing interests: None declared