Conference 2012: Alastair Scotland – Doctors, power and performance

“Contracts are needed to balance the power of doctors, creating a more equal relationship between the profession and society, and between individual practitioners and those they work with.

Professor Alastair Scotland
Founding Director (2001-2011) National Clinical Advisory Service (NCAS)

Download notes of his address here: Doctors, power, performance

Download the powerpoint here: DoctorsPowerAndPerformanceTB

Prof Scotland began by reminding the audience of the case of Harold Shipman who abused his position of power and may have had more than 250 victims. All practising doctors are in positions of power and are ascribed this power from various sources including the doctor patient relationship, the law, the way health services are structured, and in the attitude of patients and society. Medical regulation itself underpins and enhances this power gradient.

Contracts are needed to balance the power of doctors, creating a more equal relationship between the profession and society, and between individual practitioners and those they work with. When things go wrong courts often collude in taking doctors views on board, reflecting and enhancing apparently inappropriate power gradients.

The various medical scandals of the past raise questions as to whether poor performance was tolerated more than it should have been, and whether UK healthcare was able to learn from its own mistakes. The systems for responding to failures are outdated, unwieldy, bureaucratic, excessively legalistic, adversarial and court-like. Added to that is the media response, which tends to focus on blame, making it difficult or impossible to separate out individual failure from system failure and incidents which were due to no particular fault.

The response to this has been in three-phases.