Introduction

Each surgeon treats his own patients as he thinks best. The time honoured concept of clinical freedom must today be balanced by contemporary demands for accountability and value for money.

The argument that critical assessment of our work is part of the surgical ethic and anyway built into our professional lives, is powerful but no longer good enough. All of us want to make the best use of our time, and the vast majority would honestly wish for accurate information about the appropriateness of our surgical endeavours. The aims of abolishing the unnecessary, while treating the patients with the minimum morbidity and maximum satisfaction are right and proper. Audit is the cornerstone of these endeavours. It should, therefore, become an integral part of surgical practice, just as much as ward rounds, out-patient clinics and operating lists.

It is fashionable to divide audit into three components: structure, process and outcome. This may be helpful administratively but less so clinically, since undue emphasis is placed on the audit of structure and process and outcome is neglected.

Since doctors are responsible for nearly all spending on health care, they need to ensure that resources are used wisely by administrators and politicians as well as by themselves.