MEDICAL PRACTICE WITHOUT AUDIT;HOW SAFE ARE PATIENTS IN THE HANDS OF DOCTORS?- MEDICAL WAKE UP CALL

MEDICAL PRACTICE WITHOUT AUDIT;HOW SAFE ARE PATIENTS IN THE HANDS OF DOCTORS?- MEDICAL WAKE UP CALL DR FIAZ MAQBOOL FAZILI MBBS:MS:MAMS:FICA:FICS( USA ) CONSULTANT SURGEON SKIMS/KING FAHAD HOSPITAL MEDINAH MUNAWARAH PRESIDENT WALS (WORLD ASSOCIATION OF LAPAROSCOPY SURGEONS(KSA) QUALITY ASSURANCE & MAJOR DISASTER EXPERT Quran; Wa kulla insa_nin alzamna_hu ta_'irahu_ fi 'unuqih(i), wa nukhriju lahu_ yaumal qiya_mati kita_bay yalqa_hu mansyu_ra_(n).iqra' kita_bak(a), kafa_ bi nafsikal yauma 'alaika hasiba_(n).And every man's augury have We fastened to his own neck, and We shall bring forth for him on the Day of Resurrection a book which he will find wide open.(Surah Al_ISRAA v13) Is Medical practice free for all, who can prescribe what; who can perform what type of procedure; are any recommended investigations justified Recent mushroom growth of Private diagnostic centers and Nursing homes, their way of performance; focus of publicity by media on when complications happen to any patient have created some genuine doubts in our clients who are the patients; Time has gone when medical profession was considered a noble profession. If on emergency war footing AUDIT is not enforced " systematic, critical, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for the patient' we will lose the left over any reputation. Practical reasons for audit;" Quality, control", "quality assurance ","value for money", "cost effectiveness", such phrases as these or a programme of this sort will also help to provide reassurance to patients,helath care providers, and mangers that the best quality of service is being achieved, having regard to the resources available.(DOH1998).But what do they mean ?Are they trying to balance the concept of all patients receiving the sane standard of care with exercise of clinical freedom?. 'Never trust a surgeon who claims never had a complication. All operations have a complication ; the aim must be to keep these to a minimum, and the most obvious way of doing that is to monitor the outcome of all patients and in cases where the rate is particularly high, or particularly low, to investigate further , find out why, and make improvements. The ethical and moral reasons for audit make it more for all of us to make it enforceable in our practices. The surgeon owes it both to himself and to his patients to audit his results accurately and honestly. Without honesty audit is useless there is old Persian proverb that says," Fool someone and you may be clever; fool yourself and you are stupid",. this means that details of all that patients that come under surgeons care must be meticulously recorded .Ideally the practicing surgeon do this himself ,perhaps at the time that he or she performs any procedure or examination before selective forgetfulness has had time to creep in. Obviously criteria must be laid down but the Directors,Deans;Medical superintendents orCMO,S and Managers of any healthcare delivery establishment. Some clinicians may argue that medical audit is practiced already ;the ward rounds, clinical presentations; research and morbidity and mortality meetings fulfill this action. However ,there are differences between these and medical audit. Although very rarely you see these important activities done in our health care delivery system as a systemic approach to the review of clinical care to highlight opportunities for improvement and to provide a mechanism for bringing them about .there is nonetheless, general agreement that a regular review of our own practice in the light of a constructive criticism by his peers or designated supervisory body can lead to a improved delivery care for the patient. It is important that we don't lose sight of the concept that the principal beneficiary of the process that the principal beneficiary of the process should be patient. while practicing this system ethics and confidentiality should be the rule. the information used in audit about patients, must protect the confidentiality of individual patients and also that of the professionals involved. The audit should satisfy constituents of Health care are Mangers, care providers and patients. Managers want cost effectiveness, surgeons want to cure patients and keep their reputation intact with low morbidity and mortality, but what do patients want? This question is often pushed t the bottom of the list , if asked at all and it is really important if we want to maintain our reputation as noble professionals. In general patient wants competence, courtesy, kindness, and information. He or she wants continuity of care. Communication is the key. We are convinced that many law suits are instituted against DOCTORS would never have been contemplated if open communication had been maintained. Performance indicators and diagnosis related groups are not the only aspects of monitoring value for money. the economic aspects of audit have been ignored as for a long time surgeons have ignore the fact that there are not unlimited funds for healthcare and their work must be cost effective while at the same time giving patients the best possible service. New technology is expensive and becoming more so, but some doctors still have a tendency to demand the newest toy because it is available and needed or has been compared (favorably or unfavorably) with current available methods of diagnosis or treatment but due to some dubious reasons. Legal reasons for the audit; Audit is a protection for The DOCTOR, .consecutive audit of a surgeons practice can be of use if he or she is accused of mal practice. It could be seen from his/her records that his/her standard compares favorably with that of other surgeons, and that his/her mortality and morbidity for particular procedure is acceptable. Conclusions and recommendations; Audit is beneficial and protection for all DOCTOR, Patient; Mangers; and also for establishment. Can audit achieve these things ?Certainly it can help, even if at all it does a is to make a Doctor consider his/her own practice and question every stage the reasoning b behind each decision and always ask a question-could I have done better? The need for supervisory bodies ,mortality and morbidity committees ,quality management care or assurance is overdue in our health system –lack of popularity is inescapable for any segment of the community that wishes to preserve or raise standards.(Dudley1981) DR Fiaz Maqbool Fazili p.s please acknowledge the reciept of article