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Letters

Physician, regulate thyself!

Michael Goodyear
CMAJ August 30, 2005 173 (5) 465-465-a; DOI: https://doi.org/10.1503/cmaj.1050086
Michael Goodyear
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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

References

  1. 1.↵
    Can physicians regulate themselves? [editorial]. CMAJ 2005;172(6):717.
    OpenUrlFREE Full Text
  2. 2.↵
    National Steering Committee on Patient Safety. Building a safer system: a national integrated strategy for improving patient safety in Canadian health care. Ottawa: Health Canada; 2002. Available: http://rcpsc.medical.org/publications/building_a_safer_system_e.pdf (accessed 2005 Jul 4).
  3. 3.↵
    Smith J. Safeguarding patients: lessons from the past — proposals for the future. Command Paper Cm 6394. London (UK): The Shipman Inquiry; 2004 Dec 9. Available: www.the-shipman-inquiry.org.uk/fifthreport.asp (accessed 2005 Jul 4).
  4. 4.↵
    GMC reforms & clinical governance. Postponement of licensing and revalidation [online]. London (UK): General Medical Council; [date unknown]. Available: www.gmc-uk.org/cg/index.htm (accessed 2005 Jul 4).
  5. 5.↵
    Learning and personal development: appraisals [online]. London (UK): UK Department of Health; 2005. Available: www.dh.gov.uk/PolicyAndGuidance/HumanResourcesAndTraining/LearningAndPersonalDevelopment/Appraisals/fs/en (accessed 2005 Jul 4).
  6. 6.↵
    Maintaining high professional standards in the modern NHS [online]. London (UK): Department of Health; 2005 Feb. Available: www.dh.gov.uk/assetRoot/04/10/33/44/04103344.pdf (accessed 2005 Mar 29).
  7. 7.↵
    Purpose, objects and guiding principles [online]. Ottawa: Federation of Medical Regulatory Authorities of Canada. Available: www.fmrac.ca/index.cfm?fuseaction=content&ID=32&mainID=16 (accessed 2005 Jul 6).
  8. 8.↵
    Report to Health Canada. Professionalism Program. Changes in health care: charting a new course. Ottawa: Royal College of Physicians and Surgeons of Canada; 2003 Sep 12. Available: http://rcpsc.medical.org/publications/index.php (accessed 2005 Jun 28). Choose document by title.
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Canadian Medical Association Journal: 173 (5)
CMAJ
Vol. 173, Issue 5
30 Aug 2005
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Physician, regulate thyself!
Michael Goodyear
CMAJ Aug 2005, 173 (5) 465-465-a; DOI: 10.1503/cmaj.1050086

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Physician, regulate thyself!
Michael Goodyear
CMAJ Aug 2005, 173 (5) 465-465-a; DOI: 10.1503/cmaj.1050086
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