Most incompetent medical decisions remain private, confined to and rarely challenged by medically unsophisticated patients who are likely to be frightened or intimidated. This is clearly compounded by the unwillingness of other practitioners to speak up against their colleagues

In the UK in 1986 it was reported that the amount cost of medical negligence or incompetence was �19 million. Abuses have been reported in hospitals and health care facilities, and in the private offices or treatment facilities of practitioners. Specialists, as opposed to general practitioners, are most cited and frequently those treating women. In 1991-92, 1,300 complaints were received by the General Medical Council; however, in the same year only 24 reached the health procedures and 34 the conduct committee

In the USA in 1989 it was reported that there was far more medical malpractice than indicated by malpractice suits, with over 1% of hospital patients surveyed having been treated negligently. Of those so treated only 3% filed lawsuits because of the expense, the need for expensive expert witnesses and the years required to complete the trial

1. Character defects may well cause more injury than the more apparent and sensational issues of scientific ignorance, physical impairment, inexperience, substance abuse, or sexual misconduct. For example, surrendering to the desire to earn money rapidly at a patient's expense and risk; personal pride resulting in the rejection of peer advice over treatment of a patient. It is often such flaws in a practitioner's character, rather than lack of intelligence or skill, that is an essential cause of incompetence

2. Beware of the physician who is great at getting out of trouble