At most conferences on medical audit we are reminded that medical audit is centuries old. What is new is the push for medical audit as a formal activity in which each clinician must take part. This push came from Mrs Thatcher's NHS review in 1989, invoking the spirit of market forces in the NHS. Whether this spirit is that of a goddess or demon, it is perhaps too early to know. As many of the Royal Colleges (Hoffenberg, 1989; Royal College of Psychiatrists, 1989; Royal College of Surgeons of England, 1989) and the Standing Committee on Postgraduate Medical Education (1989) produced their guidelines, the push to make medical audit a formal activity in which each doctor should take part became reality in 1989.
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