Medical audit is a way of encouraging this admirable professional attribute, and standardising it so that it can be applied in everyday practice and in all aspects of patient care. It is essentially a very simple idea. (a) We decide what we should be doing; (b) we find out what we are doing; and (c) we take the necessary steps to change (b) into (a). And, Dr Farrell, please desist from sticking your fingers down your throat.'
But somewhere along the line this concept got hijacked, and medical audit developed a serious image problem; instead of being slim and sexy, it became bloated and unattractive, like the photo in the middle of this column (in my defence, the camera is fattening).
It just ain't good enough to do a simple little audit by yourself, or with other consenting adults, in the privacy of your own surgery, which might actually mean something to your daily clinical practice.
The audit cycle became a vicious circle, a noose to strangle any chance of it ever being a practical everyday tool. It developed its own vernacular - gold standards, criteria, process measuring, it spawned committees, spored journals, spewed conferences, secreted acronyms, and bred facilitators and assistants; a whole service industry mushroomed round this fatal flower.
I once won an audit competition, run by another medical journal, the prize being a cardiology stethoscope. My audit was simple: to ensure the accuracy of the BP monitors used in our practice. We had five, I checked them, found that one was inaccurate, got it calibrated, checked them again a month later and everything was rosy.
It was rough and ready, but a useful exercise. The entry for this competition required a five-line summary, but after winning I was repeatedly asked to write a full article on the subject.
Thick black stethoscopes may look smooth, but they are so damn short that measuring a BP entails sticking your face in the patient's armpit. 'It's not as if I won the lotto or a car or a luxury holiday or something,' I complained to a senior colleague, 'I'm being tormented by a crowd of shites.'
'A good definition of general practice,' he said.