Doctors: the long march to accountability

In India more than half of hospitals do not have a mechanism for managing complaints from patients or relatives (p 588). Patients find that it's impossible to prove negligence because doctors won't testify against each other. In Nigeria I met a doctor who said that under no circumstances would he give evidence against another doctor. In 1999 in Israel 765 of 792 complaints against doctors were dismissed (p 588). Many older doctors in Britain can remember such a world. The doctor was trusted and dominant. The patient was uninformed, grateful, and believed in fate. If something went wrong patients often wouldn't know, and if they did they wouldn't complain.

Slowly but surely, however, the accountability of doctors is increasing, and our news section illustrates the international range. In India the consumer movement is just beginning (p 588). The Indian Medical Association campaigned—unsuccessfully—against the inclusion of medical services under the consumer protection act, but still few cases succeed against doctors. In Israel a new health minister has within three weeks of taking office shifted responsibility for hearing complaints against the health ministry to the justice ministry, removing, he believes, a fundamental conflict of interest (p 588). In Spain a patients' association is planning to publish on its website a list of doctors who have been found guilty of negligence (p 587). The agency for data protection is trying to stop it. Meanwhile, in the United States a bill before Congress would give the public access to a database that for each doctor provides information on malpractice suits and various other offences (p 587). It's impossible to believe that such proposals will not come on to the agenda in Britain and most other countries.

The rise of evidence based health practice and the move to shared decision making fit with increasing accountability. Doctors can't just declare things to be true: they must produce evidence, and they must share their knowledge with patients. Again this BMJ illustrates the state of play. An evidence based health policy report shows how the evidence based thinking that is needed for individual patients can be applied to health policy (p 629). We welcome further submissions for this section. A survey of royal colleges in Britain shows that a third do not assess the skills of evidence based medicine in their exams (p 603), while a study shows how patients with heart failure don't feel well informed (p 605) and some letters describe the same for patients with cancer (p 632).

Finally, the best advice of the week comes from an American comedian who asks you to remember both that you are dust and ashes and that the world was created just for you (p 607).