Distinction needs to be made between audit and value judgment

EDITOR—Audits of investigations are complex, as their value to the physician depends on numerous factors, not least confidence in their own clinical diagnosis and the report. Many different specialties use electroencephalography (EEG) services. This audit imposes the values of an individual without references to practice guidelines and requires critical appraisal.

Smith et al suggest that the unrestricted access and non-specialist reporting in their district general hospital in north Wales is typical, but they do not mention that these practices are contrary to the regional guidelines that their trusts helped to formulate. 1 2 All seven EEG departments in southeast Wales comply.

One author (DS) is credited with grouping EEG requests into “influenced management,” “justifiable,” and “inappropriate.” Requests were considered inappropriate when a diagnosis (epilepsy) had been made on clinical grounds or an unsatisfactory attempt had been made to achieve a clinical diagnosis, usually failure to obtain an eyewitness account of the attack.

No rationale is given. At the time of audit six leading epileptologists in the United …