It is depressingly common to hear consultants wish for nothing more than early retirement

It is depressingly common to hear consultants wish for nothing more than early retirement."The BMA warns it would be "highly dangerous" for the NHS to change the contract to reward consultants for the number of operations they carried out or the patients they dealt with. The contract should allow young consultants to balance family life with a demanding job.In a further development, doctors' leaders disclosed that Frank Dobson, the former Health Secretary, signed the approval form to allow the 76-year-old pathologist at the centre of an investigation into 200 misdiagnosed cancer cases to continue working.There was no suggestion of wrong-doing by Mr Dobson, but it will be used by doctors' leaders in a fight-back by the profession to defend the reputation of other doctors the BMA claims are overworked because of a shortage of consultants.Mr Dobson, who stepped down to fight Ken Livingstone to beMayor of London, approved a five-week extension to the working career of pathologist James Elwood in 1998. Last week, a review was launched into 10,000 cases handled by Dr Elwood, now 78 and retired, sparking a row about the age of some health professionals.Dr Elwood's former hospital at the Swindon and Marlborough NHS trust confirmed it had sought a variation order from the Secretary of State to allow him to carry on long after his normal retirement age of 70.A BMA source said: "In the case of Elwood, the trust actually sought a variation order from the Government so that Elwood could continue It was personally signed by the Secretary of State.". Do the public think doctors are arrogant? Well, if they do, they have an odd way of showing it. Last Thursday the Government published the results of its recent questionnaire on how the public would like the extra money for the NHS to be spent There were few surprises.

Do the public think doctors are arrogant? Well, if they do, they have an odd way of showing it. Last Thursday the Government published the results of its recent questionnaire on how the public would like the extra money for the NHS to be spent. There were few surprises. One of the things people wanted was more doctors and nurses That suggests public confidence in doctors remains high. Indeed, in successive opinion polls doctors continue to command the highest levels of respect and trust of any profession or occupation in the land.So in answer to the question "Are all doctors arrogant?" I, like most people, would respond "no". It proves Alexandre Dumas's observation that "all generalisations are dangerous - even this one". But if the question is "Are some doctors arrogant?", I would have to answer "yes" - just as there are arrogant businessmen, managers and politicians.Yet all this misses the real point.

To patients, the question that matters is whether person treating them is doing a good job. Doctors' performance is the foundation on which the public's trust in them is built.The recent cases, Shipman, Neale, Ledward, have buffeted that trust. They have revealed that some doctors are palpably not doing a good job and, worse, they are not being detected until after they have harmed their patients. This gives rise to a new concern: that the profession itself has closed its eyes and ears to criticism about its regulation, and is arrogantly claiming that nothing needs changing.But far from protecting wrongdoing, we condemn any doctor who has been found guilty of medical negligence and incompetence. It is the victims of such appalling mistreatment who have our sympathy, not the perpetrators.But sympathy is not enough.

Nor is it enough to point out that these terrible cases are simply not representative of the excellent work that the overwhelming majority of doctors carry out. Under the media's microscope, millions of patients have read about loopholes which allow incompetence and negligence to go undetected. What they want is action - new policies that aim to prevent such cases from happening again, and reform of this seemingly haphazard system.The BMA wants action too We have been arguing for reform of the regulatory system We have been critical of the General Medical Council. We have taken the lead in campaigning for better systems of audit and review.We support the introduction of a new "early warning system". For many years we have endorsed the principle that doctors should be revalidated (essentially being given a MOT) on a regular basis. Together with the Royal College of General Practitioners, we have developed what we think is a workable and effective system for revalidation in general practice.Doctors have also been sent draft guidance on the standards against which they will be judged, including definitions of what constitutes excellent and unacceptable practice.This is the way to retain and build trust in doctors - by making the profession as open and transparent and accountable as possible. Like other public servants, doctors must be answerable to the society they serve.

And that society is better informed and more demanding than ever before. The old style relationship between doctor and patient, in which the patient wouldn't dream of expressing an opinion, is over. Quite rightly, patients nowadays want to be told as much as possible about the treatments they are being given, the record of the doctor, and who can give them a second opinion.The demands of patients might be changing, but what hasn't changed is the instinct of doctors to put patients first. It is why they work long and often unsociable hours, in sometimes stressful conditions - because they get their satisfaction from helping patients and making them better.Fortunately, most patients realise that. And the thought in their minds after they have visited their doctor is not "what an arrogant man!" but "thank you".. Ian Bogle has a hard job at the best of times, but after the roll of dishonour that has been exposed in past months, few can envy him his chairmanship of the BMA, obliged as he is to comment on these colleagues.