Review

Medics behaving badly

The incompetent doctor: behind closed doors
Marilynn M Rosenthal
Open University Press 1995, £12.99

When the government has to resort to setting up a hotline for doctors to report on their errant colleagues it is clear we have a problem. Of course, the problem is not necessarily one of falling professional standards. The fundamental issue is the difficulty of knowing when and how a doctor has fallen below such standards in the first place.

The Incompetent Doctor is a thorough and readable exploration of the various mechanisms-both formal and informal-which may be pressed into service when a doctor’s personal conduct or clinical practice begins to cause concern. It starts by examining how doctors think about ‘mistakes’ and how-contrary to the popular perception-come to accept the uncertainty at the heart of clinical practice and the inevitability that they will, sooner or later, make a wrong decision.

Rosenthal maps the loosely organised set of responses (it can hardly be called a system) which are available to senior colleagues, community health councils, health service managers and others, with sensitivity and insight. She describes the key stops on the journey from normal-but-eccentric to dangerous, diseased or deranged, and the early interventions: the quiet chat, the Three Wise Men, diversion of patients away from the troubled doctor. As the problem worsens or refuses to go away, the formal mechanisms come into play: the outside review, suspension, or ejection from the partnership.

An important strength of the book is that the issues are explored through the verbatim comments of all those dealing with failing doctors. Rosenthal has interviewed CHC secretaries, local medical committee chairs, regional directors of public health, consultants, GPs. What might otherwise be a rather dry and dusty area of current health policy debate becomes a fascinating account of what does go on behind those closed doors.