I was disturbed to read your Comment (29 October) about the suspension of surgeons, 'Crack in the complacency', especially in the light of your sympathetic treatment of poorly performing managers on the same page. The fallacious deduction that an increase in the number of suspensions reveals a greater readiness to voice concerns is both misguided and unhelpful: accusations of poor performance are not inevitably valid or fair, and doctors are not always suspended for good clinical reasons.

Difficulties in questioning the competence and results of clinicians were central to the Bristol case. There seems little doubt that a more open culture will lead to improvements in appraisal, clinical skills, and, most importantly, patient care. We need a move away from a secretive system of blame, to one that encourages honest and open discussion of performance and mistakes. A naive assumption of wrongdoing whenever a clinician is accused of incompetence will only maintain an environment in which blame is equated with guilt, and incentives exist to conceal errors rather than admit and learn from them.

Of course it is time to stamp out professional arrogance and complacency. It is also vitally important that we identify poor clinical performance, and act rapidly to eliminate it.

This may indeed lead to suspension or dismissal, but it is far better to identify problems at an earlier stage, when retraining or redirecting will benefit all concerned. The unjustified suspension of a competent doctor benefits no one, least of all their patients.

Dr Harry Rutter

London SW11