Black N, Thompson E
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, U.K.
Soc Sci Med. 1993 Apr;36(7):849-56. doi: 10.1016/0277-9536(93)90077-h.
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.
目前，政府、管理人员及其专业协会正在鼓励英国医生进行医疗审计。引入审计会是一项多么容易的任务呢？为了找出答案，我们采访了四家地区综合医院从事普通医学、老年医学和急诊医学工作的医生。28名顾问医生和34名初级医生参与了调查。总体而言，医生们认可审计的必要性。在本文中，我们特意关注了他们的担忧，因为正是这些担忧对于制定更好的实施方法最为重要。受访者指出的19个审计障碍可分为四类：对审计必要性和作用的认知；实际考虑因素；审计的影响；以及对审计用途的焦虑。总体而言，批评主要针对审计的实施方式，而非该方法的原则。虽然一些障碍可以通过简单的实际措施加以克服，但其他障碍则需要改变医生的知识、信念和态度。实现这些改变的难度不可低估。
