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Advances in Psychiatric Treatment (2006) 12: 397-401
© 2006 The Royal College of Psychiatrists

Uncertainty in a world of regulation{dagger}

Colin Coles

Colin Coles is Honorary Research Professor at the Faculty of Education, University of Winchester (Sparkford Road, Winchester SO22 4NR, UK. Email: colin.coles{at}sagainternet.co.uk). His background is in education: he was initially a school teacher and then a university lecturer. He was involved in the research and development of the undergraduate curriculum at the University of Southampton School of Medicine, and educational development within the Wessex Deanery for Postgraduate Medical and Dental Education. His research interests include the development of professional judgement.

Medical practice must be regulated, but the form this currently takes is increasingly based on a ‘technical’ view, which wrongly assumes that practice is straightforward and that error is the result of individual failure. The metaphor of ‘delivery’ is currently used to characterise medical practice but this usage is fundamentally flawed. An alternative is presented, supported by a growing literature, that shows that professional practice generally (and medical practice in particular) is characterised by complexity, uncertainty and unpredictability. Practitioners use their judgement and wisdom, developed in their own practice and in their contacts with fellow practitioners. Often, practitioners choose between options that are not ideal, and may need to decide on what they believe is best for an individual rather than what is ‘right’ in some absolute sense. Doctors must find ways of giving a clearer account of their practice, and in so doing become more truly accountable.


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