Introduction

When I use a word it means just what I choose it to mean – neither more nor less. (Humpty Dumpty in Alice Through the Looking Glass)

Audit is the flavour of the month in clinical medicine. The concept is not new; the attention being paid to it is. Its great attraction appears to be that it is all things to all men. To the seekers after efficiency, it offers the tool by which waste can supposedly be identified and eliminated. To the managers of the health service it is a handle which may be used to bring spending under control. To the heads of clinical departments it provides the data needed to support the firm belief that their particular service is grossly underfunded. To the competitive clinician it is the source of an eternal well-spring of information from which invidious comparisons can be made with the work of colleagues. To the computer addicted individual it provides a use for a machine that until now has proved an engrossing toy but nothing more.

To each of these people the dictionary definition of audit is the same, but the type of information and the way it is gathered to perform audit is completely different.