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Involving patients in clinical audit

This paper examines whether and how patients might be more involved in clinical audit, and it suggests an alternative, or rather complementary, approach called consumer audit. This gives patients a much more central role, despite the odds being stacked against them in a professional culture which made it acceptable for a 1989 working paper on medical audit to state quite unequivocally that "the quality of medical work can only be reviewed by a doctor's peers." Things have moved on, and there is now a growing emphasis on clinical, as opposed to medical, audit. The establishment of a Regional Clinical Audit Coordinators Group, the fact that the Department of Health's policy document on clinical audit has had to be reprinted twice to satisfy demand, and the setting up of the UK clearing house on the assessment of health outcomes are testament to the speed of change. There is a real commitment from the top to opening audit up to health professionals involved in patient care other than doctors. But how far this has permeated downwards is a question of how the rhetoric of "patient empowerment," "consumer involvement," "patient focussed care," and so on, is translated into reality.