Patients, professionalism, and revalidation

Introduction

Despite substantial efforts to modernise UK medical regulation, the General Medical Council still does not always put patients' safety first. That is Dame Janet Smith's main conclusion in the fifth report of the Shipman inquiry.1 The approach to implementing revalidation illustrates her point. Although she found that “The foundation for a system of revalidation that would command public confidence had been well laid” by the GMC, it had been seriously weakened by “substantial changes” made recently to the method of implementation “for reasons of expediency.” She said that the revised intentions, approved by the Department of Health, would no longer comprise an evaluation of a doctor's fitness to practise. Yet a competent evaluation is what the public had been led to expect and what the law now requires.

In this article I have set licensure and revalidation in the broader context of patient expectations and doctors' professionalism. I consider six linked points that need positive decisions now to help secure a successful outcome (box 1). Much of modern health care is team based, with the doctor one element in a wider system of clinical governance. Nevertheless, everybody knows that a doctor's performance is critical to the quality of the clinical process. Without good doctoring, patient care can never be safe, however comprehensive the supporting systems are. We ignore this basic fact at our peril.

All patients are entitled to a good doctor

All patients want to be looked after by a good doctor.2^–4 This is because they know instinctively that a doctor's decisions and advice about diagnosis and treatment can affect the outcome and possible consequences of illness and may make the difference between life and death. Patients equate “goodness” with up …