Paradoxical pain.

guarding the confidentiality of patients."Most lay people see the profession's scepticism as an insult to their integrity.The General Medical Services Committee's working party seems to have been unconcerned about how the public and politicians might view its proposals-otherwise it would not have proposed to increase professional control over a system already under challenge for partiality, lack of openness, and professional control.The public is unlikely to find its ideas acceptable.To suggest that most complaints are problems of communication, amenable to resolution by doctors them- selves, will not be seen as an improvement.The extension of the informal conciliatory system will not satisfy the demand for an investigative system.It is in nobody's interest to increase the adversarial nature of the procedures, yet this is what the General Medical Services Committee acknowledges would result from its proposals.Complaints should be seen as part ofthe system that assures quality and maintains standards.That requires an open, problem solving approach-and one that uses complaints to trigger reviews of standards.Agreement on philosophy would make agreement on procedures possible.These papers suggest that the profession has some distance to travel before recognising that an enlightened self interest would have it advertising for complaints and making sure that they were investigated independently.The public's expectations, raised by the citizen's charter, are unlikely to be satisfied with anything less.