Leading article: Weeding out the dangerous doctors

THEY DID NOT try to sleep with their patients; they were not drunks; they did not have a drugs problem. It is a pity, though, that Dr Wisheart and Dr Dhasmana did not indulge in any of these classic types of professional misconduct. Had they done so, the chances are that they would have been quickly caught, taken through some well-tried disciplinary machinery and been struck off before they could do any more damage. As it was, these two doctors were merely incompetent rather than venal, an equally dangerous condition from the point of view of their patients. And, as men who were simply not up to it, there was little or nothing anyone could do about their hideously bungled attempts to ascend the "learning curve" of paediatric heart surgery.

There should be no doubt that Wisheart and Dhasmana were attempting to work at a level far beyond their competence. Out of 53 babies operated on between 1988 and 1995, 29 died and four suffered serious brain damage. What makes this case so important is that it places a vital piece of common sense right at the centre of our understanding of the medical profession - that the competence of doctors to carry out their jobs varies just as much as it does in every other occupation. It is a commonplace that there are good and bad teachers, taxi drivers and plumbers; it is, rightly, no longer taboo to say so about doctors (whose mistakes can cost us a little more dearly than most).

So, if some doctors are so bad that they should not really be in practice, what can be done to ease them out? The answer, according to bodies like the Royal College of Surgeons is to introduce something called a General Performance Review Procedure. The idea is that the mortality and recovery rates of the patients under a given professional's care will be monitored. It is, of course, a concept that is capable of macabre distortion. A doctor could have a high mortality rate simply because he has been treating patients, say, in a very poor area with traditionally high incidence of heart disease. Such performance indicators, like those that have been introduced in education, must be treated with caution. But we should glance again at the Bristol case to realise their potential usefulness - the mortality rate of Mr Wisheart's adult patients was running at four times that of other surgeons.

The medical colleges have demonstrated, by their introduction of greater professional scrutiny, a willingness to address public concerns about the regulation of the various medical disciplines. They must make their new procedures stick and develop a habit of openness with patients if they do want to restore confidence and avoid an even more intrusive and less understanding intervention on behalf of those they treat.