Leading Article: Only openness will weed out bad doctors

WHO WOULD want to be a doctor? It is not a job for the squeamish or those who want an easy life. The main reason for entering the profession, for the vast majority, is the ideal of public service. For that ideal, they are prepared to work insane hours and endure accusations of high- handedness from newspapers on the relatively rare occasions when an individual doctor is found to be incompetent.

Some cases of incompetence, however, are truly alarming, such as the one we report today, the case of Rodney Ledward, who boasted obscenely that he was the "fastest gynaecologist in the South-east" and who was struck off after injuring as many as 100 women in his care.

He was found out in the end, but the question must be why it took more than 14 years to stop him. As in the case of the Bristol doctors disciplined for poor performance in baby heart operations, the machinery of scrutiny worked far too slowly.

It is curious that most gynaecologists are men, but institutional sexism will take a long time to tackle. In the meantime, what matters above all is openness and the free exchange of information. This is sometimes resisted by the medical profession, on the grounds that league tables of mortality rates and so forth will encourage litigation and force doctors into practising "defensive medicine" - but that is not necessarily so. It suggests too little faith in their own professionalism if doctors feel able to persuade courts that they have acted correctly only by adopting the most invasive and interventionist techniques. And the argument that greater openness will "encourage people to go to the courts" does not survive a moment's examination.

It will only be by the free and open availability of information that bad doctors can be swiftly exposed and swiftly dealt with.