Physician, regulate thyself!

The CMAJ editorial on physician self-regulation1 is an opportunity for us to scrutinize our own systems in an international context.

The editorial is correct in emphasizing that self-regulation is but one ingredient in what should be a closely integrated system of quality management.2 However, it would be incorrect to conclude that clinical governance in the United Kingdom has been a failure.

Dame Janet Smith concentrated on the role of the General Medical Council (GMC) in her fifth report on the Shipman Inquiry;3 as a result, implementation of the GMC's revalidation scheme, due in April 2005, was postponed.4 She was concerned about the balance of professional and public interests, specifically that revalidation as planned would not achieve an adequate evaluation of fitness to practise. This is now likely to become a responsibility of the National Health Service, tied to appraisal.5

The UK Department of Health has implemented sweeping reforms in governance, finalized in February 2005.6 Governance is now based on modern management and human resources theory and empirical psychological research. This and the GMC reforms were part of a radical response to past crises and emphasize prevention rather than blame. The success of these changes must ultimately be measured in improvements in the quality of care.

In Canada the move toward appraisal in several provinces is welcome, as is a national perspective through the Federation of Medical Regulatory Authorities of Canada.7

The Shipman case should be seen in the context of a series of tragedies and an evolving understanding of how things go wrong in health care. In the past we have handled these events poorly, and reactively rather than proactively. We should look eagerly at lessons learned in other jurisdictions to see how they might be applied in our own system.

Despite the admonitions in Dame Janet's report, physicians, patients and society ultimately have the same goals, and concentrating on what we have in common is most likely to succeed in the long run. This is the basis of what has come to be known as “professionalism.”8