Think national act local: the role of the physician and the RCP

摘要

Decision making in medicine is informed by a subtle mixture of factors: education, experience, local protocols, gut feeling, avoiding litigation. The principle of audit is that one can influence practice also by reflecting back personal performance measured against standardised averages or formal guidance. Mitchell and colleagues highlight some of the challenges herein in their analysis of computed tomography in acute presentations with epilepsy. They develop the findings of a recent national audit in the UK in selected cohorts of such patients which identified that as many as one in five patients with known epilepsy had scans following presentation to the emergency department. Many of you reading this are involved with such acute medicine presentations. They present a population level analysis over a 3-year period to identify patient factors associated with the rate of scanning. The potential of this to influence management algorithms and practice is discussed elegantly.