Topics that usually evoke heated debate among doctors include regulation, revalidation or recertification, rationing, and remuneration. Of these, the failure of regulation to ensure good and safe doctors invariably spills over into the media and is accompanied by a loss of public trust. But the issue is not black and white. As Sir Liam Donaldson, Chief Medical Officer for England, notes:
*Donaldson L. Good doctors, safer patients. London: Department of Health, 2006.
“There is little disagreement with the assertion that . . . every patient is entitled to a good doctor. Yet, there is no universally agreed and widely understood definition of what a good doctor is. Nor are there standards in order to operationalise such a definition and allow it to be measured in a valid and reliable way.” *
In the United Kingdom, professional regulation is central to the General Medical Council, which sets standards and ensures only qualified doctors are registered, and deals effectively and fairly with concerns about individual doctors. But despite these clearly defined roles, scandals such as the Bristol mishaps and the Shipman Affair continue to plague British medicine.
In Australia, our regulation system is more diffuse, with a plethora of state and territory medical boards, as well as the Australian Medical Council. Unhappily, we too have experienced damaging scandals, as instanced most recently by the “Butcher of Bega” saga.
The Council of Australian Governments has recently agreed to move to a national medical registration system. However, such a system provides no assurance that further scandals will be avoided; nor does it necessarily guarantee that every patient will be cared for by a good and safe doctor. Instead, what we will have is a national system saddled with another complex tier of bureaucracy in conjunction with state institutions, and an overlap in responsibilities.
Importantly, optimal health care delivery remains essentially a human function, and its regulation requires clear and concise communication with as little background noise as possible.
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