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'Professor Rosenthal has done her job extremely well. In an area in which there are few facts and figures, and those that exist are largely held in secrecy, she has produced a clear picture of what actually is going on and we should be grateful to her.'
Sir Raymond Hoffenberg
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' of the 'incompetent' doctor. Focused on Consultant Surgeons and senior General Practitioners, extensive interviews reveal a repertoire 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 extensive quotations from those interviewed. 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 are examined.
The book 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 commitment to effective self-regulation.
