I regard it as a singular honour and privilege to have been invited to deliver this lecture named in honour of Dr Henry Maudsley. His name is revered in medicine, not least because of his generosity in founding the Maudsley Hospital, famous throughout the world, but also because, as a former President of the Royal Medico-Psychological Association, he was active in that body out of which your distinguished college eventually evolved. The topic I have chosen is one which seems to me to be of great topical interest in an era both of increasing public scrutiny of medical practice and of the delivery of health care in a changing society. This scrutiny has brought advantages, but also substantial disadvantages to clinical medicine.