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Lessons from disclosure of audit

BMJ 2001; 323 doi: (Published 06 October 2001) Cite this as: BMJ 2001;323:815
  1. R P Symonds, reader in oncology (
  1. University of Leicester

    We are supposed to audit all aspects of practice. Problems arise when you find something unpleasant. This is what happened in Leicestershire this spring. Our pathologists carried out a retrospective audit of the cervical smear history of 403 patients who developed invasive cervical cancer between January 1993 and September 2000. Of these women, 324 (80%) had had a cervical smear before diagnosis and their test results were re-examined. In 84 cases a false negative report had been issued; in 38 cases the cytological abnormality had been undergraded.

    Relatives, especially, tended to blame the messenger

    Twenty of the 122 patients had died; diagnostic delay was an important factor in 14 deaths. The same diagnostic delay led to 64 patients having more radical treatment than necessary. Despite what seem to be shocking results, there is no evidence that the Leicestershire laboratory is failing. Indeed, quality assurance tests have shown that the laboratory is at least as good as comparable departments.

    The …

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