'Imagine hearing: 'This is your junior pilot speaking. I have no particular interest in your safety.''

For centuries there has been an implicit contract between the medical profession and the public. Medicine was seen as morally strong and ethical, the profession regulated itself and set its own standards, and government and society placed trust in the profession.

Recent events suggest this contract is now in its death throes. Setting aside the government perspective, doctors' long-assumed right to top the list of most-trusted professions is being called into question. Doctors and medical students are now suspected terrorists, GPs are described as greedy in the tabloids, and patients and the public are increasingly questioning the authority of the profession.

Seeing patients as.consumers of healthcare has much to be said for it. As the daughter of a shopkeeper, I remember hearing the phrase 'the customer is king', but that idea.is now more overt. A utility company recently sent me a£20 cheque for not honouring its own deadline for responding to a letter of complaint. What might the equivalent standard be in healthcare? How will we be expected to recompense patients when their expectations of a particular outcome are not met?

Check and check again

As part of its centrally procured contracts in diagnostics services, CareUK is.expected - like all independent sector providers - to quality assure a minimum of 10 per cent.of its work. This is not a standard imposed within the NHS, but we are learning a great deal from it.

A colleague providing radiology quality assurance to us felt his own trust should undertake a comparable internal process. This was carried out for a couple of weeks and demonstrated that the vast majority of reporting was of a good standard. Thanks to additionality, our own reporting is undertaken by doctors who have not been in recent NHS employment. As it turned out, a small percentage.was not of a high standard and needed to be re-reported.

In endoscopy, similar work has been undertaken and published - showing that there are significant variations in reporting between different endoscopists, which is unlikely to be explained by casemix or chance. The authors conclude that more emphasis should be placed on the correct interpretation of endoscopies during training.

Seeking patients' views

The Royal College of Surgeons has also been investigating patient-reported outcome measures since 2005. PROMS have been piloted in treatment centres in the NHS and independent sector across a range of simple procedures. The measures chosen are based on the literature and are intended to detect differences in performance between different units and teams, as well as investigate the effectiveness of different techniques. In other words, the hip replacement may have been uneventful, with reasonable recovery, but if the patient expected to be able to play golf and can't, they may see that as a disappointing outcome. Using the system ensures that.the expectations of patient and doctor are reasonably aligned before the operation - so that the disappointed patient can make the right decision, based on realistic expectations, at the outset.

To ensure continued respect and trust from the public, we need to be self-critical and implement systems that scrutinise practice. We need to ensure that we keep pace with the demands of technology. In the field of patient safety and the impact of human factors, the profession has been a late adopter compared with other professional groups where lives are at risk.

The public is now more vociferous and aware of the likelihood that things could go wrong. Anybody who has heard the wonderful Martin Bromiley speak will have squirmed in their seat about the nature of his wife's death, aged 37, following a routine operation. His own journey has driven him to ensure that we take on board the impact of human factors in a systematic way. He cites a paper on safety, signed by a junior doctor 'with no particular interest in patient safety'. Translate this and see how good it sounds. Imagine hearing: 'This is your junior pilot speaking. I have no particular interest in your safety.'