Mandatory regular meetings of hospital staff would complement medical audit and revalidation

Editor—The current ideas and discussions in the United Kingdom about the maintenance of high standards, medical audit of outcomes, revalidation, etc, miss a tremendous opportunity to make this a positive educational exercise.

I spent 10 years in the NHS (1951-61) and have subsequently spent more than 30 years in the American healthcare system. I believe that the mandatory regular meetings of hospital staff in every clinical department in the United States are one of the most powerful approaches to medical outcomes, and therefore to the competence of the doctors responsible for the cases under discussion. This applies particularly when the conference concentrates on deaths and complications. My view is based on my experience as a participant, contributor, and organiser at varying times.

Revalidation by examination, peer review of outcomes in one's patients, and formalcontinuing medical education sound good and will assuage public concern but are certainly not evidence based. No doctor wants to appear a fool in front of his or her colleagues. What better way to motivate doctors to keep up to date and practise good, thorough, and safe medicine than to use this as the stimulus?

In addition, the tissue committee and the audit committee have important roles. The tissue committee, at monthly intervals, evaluates a report on every piece of tissue surgically removed. Where there is discrepancy between the specimen and the preoperative diagnosis the responsible surgeon has to justify—albeit initially mostly in an academic sense—his or her course of action; repeated discrepancies of this kind will lead to restriction of independent surgical privileges and possibly suspension.

The audit committee chooses several diagnoses—medical, surgical, gynaecological, etc—and reviews 20 or 30 medical records in these categories every month. The outcomes are reported to department chiefs. If doctors fall below accepted standards their independence will be restricted and they may be retrained.

Every member of the hospital staff knows of the existence and function of these committees and of the various conferences. Thus one cannot escape having one's work and outcomes reviewed in public, whether by committee and department chiefs or by question and discussion at clinical case presentations. I believe that this or a similar system in the United Kingdom would complement the present suggestions regarding medical audit and revalidation.¹ It would almost unavoidably convert a very intermittent imposed regulatory method into a truly continuing and continuous medical education.