Medical regulation, spectacular transparency and the blame business

The purpose of this paper is to explore general practitioners' (GPs') and psychiatrists' views and experiences of transparent forms of medical regulation in practice, as well as those of medical regulators and those representing patients and professionals. The research included interviews with GPs, psychiatrists and others involved in medical regulation, representing patients and professionals. A qualitative narrative analysis of the interviews was then conducted. Narratives suggest rising levels of complaints, legalisation and blame within the National Health Service (NHS). Three key themes emerge. First, doctors feel “guilty until proven innocent” within increasingly legalised regulatory systems and are consequently practising more defensively. Second, regulation is described as providing “spectacular transparency”, driven by political responses to high profile scandals rather than its effects in practice, which can be seen as a social defence. Finally, it is suggested that a “blame business” is driving this form of transparency, in which self-interested regulators, the media, lawyers, and even some patient organisations are fuelling transparency in a wider culture of blame. A relatively small number of people were interviewed, so further research testing the findings would be useful. Transparency has some perverse effects on doctors' practice. Rising levels of blame has perverse consequences for patient care, as doctors are practicing more defensively as a result, as well as significant financial implications for NHS funding. Transparent forms of regulation are assumed to be beneficial and yet little research has examined its effects in practice. In this paper we highlight a number of perverse effects of transparency in practice