In the UK, the issue of medical regulation and public trust is now highly politicised. Yet the UK is not alone in finding that citizens and doctors are having to redefine their traditional relationship. In all countries, citizens are demanding more and better health care and governments are having to respond. Frequently this response includes attempts to reform the way in which the medical profession is regulated. As in the UK, governments are finding that it is a complex and difficult arena in which to introduce change. Direct and indirect regulation are both options which can be used. Under pressure from their citizens, governments face a dilemma. Public trust in the authority of doctors needs to be maintained or restored if the profession is to continue to deal with the demand-supply mismatch in the quantity and quality of health care. Yet to rely on the profession to manage its own process of organisational change to achieve that trust is gambling against history. On the other hand, the introduction of regulatory reform for which the state takes responsibility means that it, rather than the profession, then becomes the target for citizen discontent with the standards of health care. The political advantage of medical self-regulation to the state has always been the distance it places between itself and its citizens.