EVEN if this rather obvious development is centuries late, I welcome the intention that physicians should undergo annual appraisals and five-yearly reviews which, in extreme circumstances, could result in their being struck off.

I was equally delighted that such assessments will not be confined to the strictly clinical aspect as, especially when the patient is particularly ill, the medical advisor’s tactless, insolent and arrogant observations can cause considerable extra suffering, often with little or no right of redress – a supreme example of adding insult to injury.

So far, so good but who checks the checkers? What guarantee will there be of the examiners’ aptitude and integrity?

To what extent could not only clinical failings but also obnoxiousness, addiction to alcohol or other drugs, inappropriate touching of the vulnerable, etc, be masked during such evaluations?

And will the bureaucracy, not least in the present climate, prove to be cost-effective?

I have just heard that the newly-appointed Secretary of State for Health has asserted that more 0.7 per cent of physicians are grossly inadequate, a figure difficult to reconcile with the fact that one in seven general hospital admissions is largely deemed to be at least partly iatrogenic (i.e. doctor-created in whatever manner) in origin.

It is widely believed that there are still more than a million patients in this country chronically and desperately hooked on prescribed “medication” that appears to cause or accelerate dementia.

Finally, I was unashamedly glad to learn that overseas physicians are to be included in this process. I trust that all those lucratively engaged to examine their colleagues’ performance for civil legal purposes will be subject to the most rigorous scrutiny.

DAVID DIMENT Riverside Court Oxford