Professional regulation and attitudinal issues: constructing the 'good doctor' and the 'bad apple' through the device of insight.

Abstract

In fitness-to-practise hearings for doctors and other health care professions, the practitioner's 'insight' into their past misconduct or deficient performance takes centre stage in determining outcomes. Although insight does not feature in the statutory framework, it has emerged as a regulatory device used to distinguish the 'good doctor' from the 'bad apple' who should be excluded from the profession in order to protect the public. This article frames the concept of 'insight' in professional discipline as an example of Foucauldian avowal-a ritual of truth-telling which requires the doctor's full acknowledgement and admission of wrongdoing and a disavowal of their former self. If successful, avowal enables reintegration of the practitioner into the profession's social order. 'Insight' is then tracked as a contested site in doctors' fitness to practise appeals across a period of more than 25 years, exploring its clinical origins, expansion, and modern application. The accumulated case law confirms insight as a deeply embedded staple of fitness to practise decision-making and a core regulatory strategy for protecting patients, while highlighting that it is inevitably compromised by issues of authenticity.