Professional accountability in a changing world

摘要: The context in which medicine is practised Britain has changed beyond all recognition since the profession took its first strides into comprehensive system of heath care enshrined postwar ideal a national health service. For 40 years National Health Service accountability doctors was to their patients and broad non-specific professional code. NHS at provided setting where could “exercise skills with almost complete autonomy”.1 There been major change emphasis during last 15 years. advent managed mid-1980s2 led clinicians gaining responsibility for own budgets service directorates time when there were few existing channels accountability. In early 1990s charters quality guarantees generated3 as rights users acknowledged, defined, documented. philosophy evidence based medicine4 raised an expectation created requirement that clinical decisions be on what known effective, rather than individual preference. This operationalised partly through production guidelines5 increasing number diseases patient groups. The decade brought broader exposition principles good practice conduct. so doing obligation placed meet more explicit higher standards.6 A statutory duty organisations late being implemented concept governance.7 All these changes have highlighted continuously strive develop professionally—to acquire retain skills, access use best evidence, participate planning quality, …