The Incompetent Doctor: Behind Closed Doors

The Incompetent Doctor: Behind Closed Doors

The Incompetent Doctor: Behind Closed Doors

The Incompetent Doctor: Behind Closed Doors


'Professor Rosenthal has done her job extremely well. In an area in which there are few facts and figures, and those that exist are largely held in secrecy, she has produced a clear picture of what actually is going on and we should be grateful to her.'
Sir Raymond Hoffenberg

Based on qualitative, ethnographic research carried out in England and Sweden, this book examines a neglected area of professional self-regulation. It explores the range of informal and quasi-formal mechanisms used by doctor colleagues, health care managers and professional organizations in attempts to cope with the 'problem' of the 'incompetent' doctor. Focused on Consultant Surgeons and senior General Practitioners, extensive interviews reveal a repertoire of mechanisms that include, amongst others, the 'Frank Talk', 'Protective Support', the 'Veiled Threat', being 'Forced out of the Partnership', the attempted 'Golden Handshake' and, when all else fails, 'Stalemate and Marginalization'. Each chapter includes a number of specific cases as well as extensive quotations from those interviewed. How information is gathered and assessed, the relative success or failure of these mechanisms, the factors that determine their use or non-use, medical perceptions of mistakes and the changing attitudes of the public are examined.

The book includes a discussion of current changes in the National Health Service and their likely impact on these issues and quality assurance in medical care. Some comparisons with the informal processes in Sweden provide insight into the universality of the informal mechanisms. The book ends with a proposal for a total, integrated peer review system that recognizes and strengthens the informal mechanisms and links them to systematic clinical practice analysis and other efforts that enhance the medical profession's commitment to effective self-regulation.


Health services in many developed countries have come under critical scrutiny in recent years. in part this is because of increasing expenditure, much of it funded from public sources, and the pressure this has put on governments seeking to control public spending. Also important has been the perception that resources allocated to health services are not always deployed in an optimal fashion. Thus at a time when the scope for increasing expenditure is extremely limited, there is a need to search for ways of using existing budgets more efficiently. a further concern has been the desire to ensure access to health care of various groups on an equitable basis. in some countries this has been linked to a wish to enhance patient choice and to make service providers more responsive to patients as ‘consumers’.

Underlying these specific concerns are a number of more fundamental developments which have a significant bearing on the performance of health services. Three are worth highlighting. First, there are demographic changes, including the ageing population and the decline in the proportion of the population of working age. These changes will both increase the demand for health care and at the same time limit the ability of health services to respond to this demand.

Second, advances in medical science will also give rise to new demands within the health services. These advances cover a range of possibilities, including innovations in surgery, drug therapy, screening and diagnosis. the pace of innovation is likely to quicken as the end of the century approaches, with significant implications for the funding and provision of services.

Third, public expectations of health services are rising as those who use services demand higher standards of care. in part, this is . . .

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