Three million people in the UK have doctors who are not fit to practice, according to the former president of the UK's General Medical Council (GMC), which registers and disciplines all doctors in Britain.
Sir Donald Irvine, who retired two years ago from the GMC and now chairs the Picker Institute Europe, a charity promoting healthcare from a patient perspective, says that far too many people in Britain have doctors who are incompetent or just not good enough at the job.
The really bad doctors may be brought to book because of their mistakes and struck off the medical register. But there are many others -- possibly more than 11,000 -- whose failings will only be detected through the revalidation process, a five-yearly check on their fitness to practise that Sir Donald pioneered at the GMC and which he fears is not being implemented as he had expected.
Last year, 142 doctors were erased from the register, although 85 of those were voluntary erasures and 18 were doctors whose cases had been heard in previous years. There were 83 suspensions and 130 doctors had conditions put on their registration. That year there were 3,962 new complaints.
"People believe they should have a good doctor -- it shouldn't be left to chance," Sir Donald told reporters.
"The poorly performing doctor doesn't quite know what he is doing scientifically or talk to his patients properly. He makes avoidable mistakes because he's not up to date."
If you have a doctor who does not talk to patients properly, he said, "you can't really engage in your treatment properly, understand what's happening to you and how to take your medication, which is the starting point for self-care and helping yourself.
"Good communication is just as important as being able to take the blood pressure. Patients understand that, they think it's part of the deal. Some doctors think it's an option."
In a recent lecture, Sir Donald, the first family doctor to become GMC president, said the quality of care "can affect the outcome and possible consequences of illness, and at times mean the difference between life and death. Illnesses can make patients frightened and vulnerable, and bring their defenses down. These are the reasons why all patients want good doctors who are properly skilled and fully up to date, who really know what they are doing."
Dame Janet Smith, who chaired the inquiry into the murder of at least 215 patients by the UK family doctor Harold Shipman, was highly critical in her final report this week of the GMC's failure to drive through reforms so that doctors' competence can be fully assessed every five years.
The GMC had recognized the need for change after scandals such as that at the Bristol Royal Infirmary in the west of England -- where babies died in heart surgery because doctors were not good enough at the procedures -- but she felt that under the present proposals, the GMC would not be assessing doctors but relying on hospitals and their managements to do it.
Sir Donald says that 5 percent of the roughly 230,000 doctors on the GMC register are probably unfit to practice for a variety of reasons, including losing their skills, failing to keep up to date, incompetence and ill-health.