The core of competence.

In 1965 a leading journal published an article entitled 'What should the profession do about the incompetent physician?'. 1 The paper, published by a doctor in Mexico, was seen as provocative. The author was vilified on the front pages of leading newspapers across the United States. There then followed a series of telephone calls usually of an abusive nature and poison pen letters from both the general public and the profession. A mere eight years later, the author presented a paper on a similar theme to the National Congress on Medical Ethics in Washington. The paper 2 contained far stronger statements than the original article but there was no hate mail and no abusive telephone calls. The winds of change had swept medical competence into the collective conscience of the profession. Today's literature has two types of paper on competence: those papers that cover aspects of general clinical competence, and a second group dealing with competence in a specialty. Occupational medicine has now joined that second group. 3 The document reports the proceedings of a conference held in 1997 at the University of Glasgow and took as its working definition of competency: 'the possession of sufficient physical, intellectual and behavioural qualifications (i.e. knowledge, skills, abilities and attitudes) to perform a task or serve in a role which adequately accomplishes a desired outcome'. The definition is clearly based in practice. Once the definition of competency is established for a specialty, then it is easier to accomplish quite a range of different objectives. Perhaps importantly, it permits the identification of the incompetent occupational physician. Whilst occupational medicine is not generally regarded as a specialty with a high clinical risk, from time to time the nature and understanding of our specialty is tested in the courts. Lawyers, judges and tribunal chairpersons become confused by the concept of occupational medicine and the role of occupational physicians. Tribunals are beginning to give decisions in cases which impact on the nature of the competency of the medical adviser to the respondent company. When occupational medicine is subject to such adverse misunderstanding the result is a great detriment to our specialty. How will the definition of competency help? It may usefully help to justify the recognition of occupational physicians as competent to give advice in the questions upon which the courts and tribunals must decide. We must be prepared to bring these statements to the fore, whenever …