Suspending a doctor for poor performance is a drastic step. It's far better to get to the problem earlier in the day, says Alastair Scotland, head of the NationalClinical Assessment Authority

A switch from plastic surgery to public health–from the most hands-on specialty to one of the least–is surely not among the more common career moves in medicine. But such is the route that Alastair Scotland has followed to his present job as chief officer and medical director of the National Clinical Assessment Authority.

Alastair Scotland (pictured): when employers don't follow his recommendations, he would like to know the reason why, but he doesn't want them bludgeoned into line

“If you've ever done surgery, you do miss the excitement, the hurly burly of the acute situation,” he admits. However, if part of the appeal of medicine is being able to observe the human drama at first hand, running the new authority is hardly short of drama–involving as it does advising on what to do for and about doctors in difficulty.

Perhaps even a bit too dramatic: isn't it depressing to have to deal with a passing parade of the inadequate, the incompetent, and the simply fallible from within your own profession? Scotland finds the question amusing. Far from being depressed, he says, he loves the job–it's interesting, stimulating, and exciting. And, …