Medical audit in France: from ideal to reality.

Conclusions Quality assurance as such is mainly a question of attitudes and behaviour. It is difficult to induce doctors to modify their behaviour by pressures other than from inside the profession. In France there are three types of understanding of medical evaluation: that of the official bodies and evaluation units of hospitals, who try to define and disseminate actual quality assurance; that of doctors, who often confuse it with clinical research; and that of government, whose main problem is financial. The fact that, except in the Netherlands, quality assurance has always been promoted by governments or health administrations, or both, and never by the medical profession itself constitutes in the eyes of doctors an original sin that is difficult to overcome. It could also turn against quality assurance itself when governments eventually find out that quantity and quality belong to two different logics and that quality assurance does not necessarily entail savings. Therefore many problems remain before quality assurance can be integrated routinely in medical practice. Clarification is needed about the concept of quality assurance and the activities actually covered by quality assurance. Clarification is also needed about the government's intentions and its role in developing and managing quality assurance. Ideally, quality assurance should be adopted by the medical profession as an activity of its own, independent of any public or administrative policy. This is not yet the case in France, but things may be stirring.