If excellence in patient care is to be our aim and priority then serious deviations from this path must be defined and dealt with early in the life and practice of any surgeon. ‘Red flags’ are often seen in training years but should have been recognised and dealt with prior to selection (or even undergraduate years).

Dealing with the dysfunctional or incompetent ‘registered surgeon’ may not be quite as simple, however, and is doubly difficult if the ‘surgeon of concern’ seeks to ‘cross borders’ or seek registration in other countries/states. Although registration boards/councils have been the ‘gate-keepers’ of this process in the past, the complexity and volume of work has expanded enormously. The legal system has been involved (with great and good effect in some instances) but perhaps to the detriment of the process and certainly in a form that becomes a serious impediment to rapid resolution of the problem both in time and cost.

In Australia, states and territories have set up Commissions that may be more effective. Legislatively, the ‘Health Quality and Complaints Commission’ in Queensland was set up to deal with complaints about medical/surgical health care delivery in all sectors of the community.

The author looks at the ways in which surgeons' input into these structures might assist and substantially improve the processes by which the continuing problems surrounding poor surgical practice and professional behaviour may be effectively dealt with in a time- and cost-effective manner.