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" or "incompetent" doctor. Focusing on consultant surgeons and senior general practitioners, extensive interviews reveal a repetoire 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 quotations from those interviewed. The book examines 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. The text 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 commmitment to effective self-regulation.
"...a thorough and readable exploration of the various mechanisms - both formal and informal - which may be pressed into servicewhen a doctor's personal conduct of clinical practice begins to causeconcern...What might otherwise be a rather dry and dusty area of current health policy debate becomes a fascinating account of what does goon behind those closed doors." - Health Matters "...a genuinely useful treatment of a little-aired issue. In dealing with the incompetent doctor, she offers fascinating insights into the shadowy world of the regulation of medicine. She makes powerful andthought-provoking observations about the sense of personal vulnerability that most doctors share, and her refusal to indulge in doctor bashing is most refreshing. This book is important not only because of itssubject matter but also because it adds to the growing weight of evidence in favour of using qualitative methods to investigate matters of interest in the health services...is a fine piece of work, which admirably achieves its aim of contributing to debate about the future of health services, and is particularly timely given the recent announcement of the 'Shop a Doc' scheme. It is to be hoped that the exploratory work it reports, and the hints offered about directions for future research, will stimulate much further investigation and theory" -Health Psychology Update "This thoughtfully researched and written book is a notable contribution to the literature on medical quality management. In highlighting the powerful psychological andsocial forces that impede the prevention and minimization of errors in health services, it underscores the need for targeted strategies which are "continuing, consistent and creative" in identifying and improving on processes that result in patient risk." - American Journal of Medical Quality "...knowledgeable, intelligent, well- organised study." - Journal of Health Politics, Policy & Law "For those interested in professional socialization and medical sociology, this study contributes to the identification of universal norms of professional behaviour and relationships." - Contemporary Sociology