Atopic eczema

have progressively lowered our threshold for seeking consent. We don't yet insist on written consent from patients for all case reports, but we may eventually do so. This week's case before the General Medical Council also shows that doctors must be very clear about what the patient has consented to: vague statements about the information being used in teaching and research will not be enough. Patients must be told that the material will be published, and ideally they should see a final draft of the paper to be published. Indeed, one of the expert witnesses in the case argued that doctors and patients might negotiate over what appears in the final version. Editors, who often want substantial changes in papers, must also be part ofthat process. Those who dread (as I do) the arrival of more process and bureaucracy may think that we are going too far. Surely, the argument goes, publication of reports on patients is essential for medical education and the development of medical knowledge, and the small risk that patients may be identified is outweighed by the overall benefit. But some patients are very distressed by discovering that material has been published about them without their consent; medical journals and textbooks are read by non-doctors; and most patients will give consent, which means that the advance of medical knowledge will not be impeded. We have to do better.