MAM in favour of proper medical audit - The Times letter
MAM in favour of proper medical audit
Martin Balzan, general secretary, Medical Association of Malta, Gzira.
I refer to the recent editorial stating that the "medical profession has successfully resisted medical audit for far too long" and that "the MAM's reaction would have been far more impressive had it proposed clinical audit itself".
This is very surprising because, as the health authorities are fully aware, one of MAM's conditions after industrial action in 2001 was the introduction of medical audit. A substantial part of the agreed increase in salary is dependent on the individual doctor performing a yearly audit which has to be approved by an independent committee. MAM agreed with the government to implement a complex structure so that appropriate safeguards were built into the audit system.
This led to the setting up of the Quality Assurance Initiative Adjudicating Committee specifically to regulate the audit reports submitted by doctors. In this way audits can improve the service rather than promote a defensive mentality among medical practitioners. The QAIAC is not just on paper, but up and running and has, since its inception, received and approved hundreds of audit projects - a far cry from The Times editor's assertion that the medical profession's response was one of resistance.
MAM is in favour of proper medical audit and it has participated in its detailed methodology to make it effective. Any proposals for discussions to further refine and develop this system are most welcome.
The editorial also chastises the government for not providing the tools for audit because of problems with data access. MAM would like to emphasise that the concept of audit applies to anything within the health service. Audit can equally be applied to the administrative systems in place and not merely to one doctor compared with another. One major problem is that the hospital administration rarely takes the necessary action when audit highlights a system deficiency.
As an example, various local and foreign audits have highlighted the risks of hospital-acquired infection caused by hospital overcrowding. Despite this, hundreds of Maltese patients are still being treated in corridors. Audit has also shown for the last several years that, because of "social cases", St Luke's Hospital is unable to cope with the added medical admissions during the winter months. This repeatedly results in the uptake of numerous surgical beds and hundreds of cancelled operations besides the notoriously familiar sight of patients in corridors. Only now are we seeing an attempt to address this major problem.
The Medical Association of Malta hopes that the hospital administration will embrace audit in the same way that doctors have been doing during the past five years. Malta needs competent hospital decision makers who are prepared to act on audit results, not just shift the blame on the medical profession without taking any decisive or effective action on the problems affecting the health service.