ABSTRACT
Research from the US has found that a significant improvement in the overall quality of medical practice is marred by a small percentage of repeat defaulters. In asking why self-regulatory mechanisms fail to satisfactorily deal with this minority, one conclusion is that social and peer control mechanisms are relatively ineffective. Efficient collegial influence relies on a sufficient depth of identification by individual practitioners with the professional group, the degree of solidarity of that group and the capacity of the group to provide meaningful guidance regarding standards of conduct. However, with increasing group identification and solidarity comes an increasing likelihood that group members will protect one another from outside scrutiny.In essence, there is an inherent tension between bonds of professional collegiality and peer enforcement of rules.1 Close proximity in working relationships between members of professions is therefore more likely to breed consensus which discourages whistleblowing.2 Doctors are likely to avoid confronting or reporting colleagues in all but the most exceptional circumstances.3 They might attempt to avoid working with such colleagues, but often no action was taken to prevent them moving elsewhere. If a doctor, nurse or other practitioner did formally report a colleague, it was often the whistleblower themselves who found themselves ostracized or punished in some way.4
