Rethinking Medical Audit PDF Download

The report describes the development of a new risk management culture within professions, companies and governments. The obsession with managing risk is creating organisations which are not so much risk averse as ‘responsibility averse’. In medicine, doctors are practising ‘defensive medicine’ where opinions are heavily qualified with caveats and patients left to make big decisions. The report also refers to growing evidence that since Enron’s failure, major accountancy firms are declining to work with ‘high risk’ clients - the very ones that should be thoroughly audited. “When disclaimer paragraphs are longer than the professional opinions they follow, we know something has gone wrong,” says author Professor Michael Power, a director of the ESRC Centre for Analysis of Risk and Regulation at the London School of Economics. “In the interests of transparency, small print should be made large and ruled out as a secondary risk management ploy. “The trends in professions such as medicine and auditing signal a withdrawal of individual judgement from the public. Minimal records are kept, staff are cautioned about the use of email, and normal correspondence is littered with disclaimers. The risk management of everything implies a society of ‘small print’.” Power sees the rise of the ‘risk management of everything’ as a related trend to the audit culture, which included the government’s now widely criticised love of targets as a policy tool. The Audit Explosion, Power’s previous Demos pamphlet, predicted that the overuse of audit leads to a focus on measurable outputs rather than real outcomes. “The most influential dimension of the audit explosion is the process by which [organisations] are made auditable and structured to conform to the need to be monitored,” Power wrote in 1994. Power’s new book argues that risk management is the ‘new audit’ and is having a similar distorting effect on the performance of professionals, companies and government.