Debating the patient's "right to know"
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* C. David Naylor

**[Dr. Naylor responds:]** 

I will address one issue that, from media accounts, has galvanized public interest in seeking more publicity about college disciplinary proceedings: venue-shopping by physicians who have lost their licences in one province and successfully seek licensure elsewhere. I do not know how often this occurs, but the solution is tougher and more consistent self-regulation. This includes cooperation among the colleges to keep sexually abusive, chronically impaired or incompetent physicians out of practice in every province unless there is unequivocal evidence that it is safe for them to resume clinical work - with or without ongoing conditions and supervision.

I understand that the Federation of Medical Licensing Authorities of Canada has initiated more systematic sharing of information on discipline and assessment proceedings, and it is also testing a system of unique national identifiers for all licensed physicians.1

As Robson argues, available research suggests that successful malpractice suits are neither specific nor sensitive measures of clinical competence. Disciplinary actions appear more specific but are hopelessly insensitive to most of the systematic quality problems in modern medical care. Although I accordingly question whether individual patients will truly benefit from better access to this information, informed consent is not the only rationale for Kluge's proposal. In an essential-service sector where the state has ceded substantial self-regulatory privileges to providers, the balance must inevitably be weighted in favour of transparency - the public's "right to know." With due attention to practicalities and potential pitfalls, Kluge's proposal merits serious consideration on the latter grounds alone.

## Reference

1.  1. Wharry S. Every MD will soon have unique "cradle-to-grave" identifying number. CMAJ 1999;160(6):896.
    
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