Obstacles to medical audit: British doctors speak

Currently, British doctors are being encouraged by government, managers and their professional associations to undertake medical audit. How easy a task will it be to introduce audit? In an attempt to find out, doctors working in general, geriatric and accident and emergency medicine in four district general hospitals were interviewed. Twenty-eight consultants and 34 junior doctors participated. Generally speaking, doctors accepted the need for audit. In this paper we have focussed deliberately on their worries, since it is these which are of most importance in developing better methods of implementation. The 19 obstacles to audit that respondents identified can be grouped into four categories: perceptions of the need for and the role of audit; practical considerations; the effects of audit; and anxieties about the use of audit. In general, criticisms were levelled at the way audit was being implemented rather than at the principles of the approach. While some obstacles could be overcome by simple, practical measures, others will require a change in doctors' knowledge, beliefs and attitudes. The difficulty of achieving such changes should not be underestimated.