Published: 10/02/2005, Volume II5, No. 5942 Page 38

Doctors work in a field advancing so rapidly that the total sum of knowledge is doubling every few years just in a few specialist areas, let alone the whole subject.

Following the final report into the Harold Shipman tragedy it seems all the recommendations fail to grasp that to detect as well as prevent failure in such highly trained experts requires specialist systems of sufficient knowhow, and not simply well-meaning lawyers, concerned politicians or interested members of the public.

An intriguing example of this point comes from a recent study. Using a complex statistical analysis of annual deaths of patients of over 1,000 English family physicians for the latter half of the 1990s, it investigated whether it was possible to pick up automatically when doctors attracted a higher mortality rate than should be expected.

Of 1,009 family physicians, 33 (including Shipman) crossed the alarm threshold designed to detect an unusual increase in mortality rates.

Physicians in nursing homes or hospices are likely explanations for most of these additional alarms.

The study illustrates the need to involve statisticians, epidemiologists and a whole host of other experts in devising systems sophisticated enough to detect quickly when an expert is straying off the rails.

The only way to ensure doctors and managers are thoroughly up-to-date is to make retraining a routine and rewarding part of career development after qualification for physicians and managers. That means regularly taking them out of their service role for extended intervals to review, improve and add to their skills.

This would remove the menacing and castigatory elements of current medical revalidation plans, and it would gear the profession to long-term prevention rather than short-term cure after a complaint.

This kind of intensive scrutiny is the only way to raise the standards of medical practice. But it is going to cost much more than current NHS thinking allows. If you want your doctor and your manager to look after you well, then you are going to have to look after them too.

Raj Persaud is consultant psychiatrist at South London and Maudsley trust and Gresham professor for public understanding of psychiatry.