As Chair of the surgical audit in the Bristol Royal Infirmary I sometimes muse, while boring morbidity and mortality detail drones on: 'Why should surgeons audit?' This same question is posed in the preface to Surgical Audit by Pollock and Evans. The beginnings of the answer are 'Everybody in the world is entitled to the same high quality of medical care. This must not be a pipe dream and the World Health Organization aims at this target by the year 2000'. This is the beginning of the rationale of audit. It clearly is a pipe dream and a tragedy that the WHO has such misguided and unobtainable aspirations. Surgeons must not be misguided, however, but within their domain strive for the best for their patients. Audit is one way in which that aim might be achieved.
The second edition of this book is considerably longer than the first and printed on poorer quality paper, but the authors have audited their first edition to produce an excellent second. It continues to be an entertaining and educational work with its introductory aphorisms and remarks, my favourite being: 'I beseech you, in the bowels of Christ, think it possible that you may be mistaken' (ascribed to Oliver Cromwell in 1650).
The book is eminently readable and set out in a pleasingly varied style. Important elements are clearly listed and highlighted. It can be dipped into if you wish to read self-contained sections. The topics progress from the history and definition of audit, through audit of structure and process to the audit of outcome measures. Patients are not forgotten, with consideration given to ethical, experimental and patient satisfaction issues. The British Journal of Surgery and its editorial team are audited in detail in a section on 'Audit of publications'. The reader will have to buy the book to see what the authors say about the Journal.
All sections of the book have been comprehensively updated, whether this be to cover new technology, such as laparoscopic procedures, or medicolegal or ethical issues. Some points remain unanswered, such as the effects of cost containment, the search for efficiency, and disease or illness priorities. The front cover has changed from blood red to surgical green. I think this means 'go' (to your bookshop to buy a good enjoyable read). I look forward to a third edition in which the authors will demonstrate that the audit process and the resources poured into it have produced worthwhile results.