Uncertainty in medicine: can it be reduced?

acquire those skills are rarely offered. Consequently a nursing perspective on audit methods tends to select techniques such as continuous observation, peer review, and case study approaches rather than a quantitative approach. The picture emerging then is one in which different health care groups working ostensibly together will perceive different topics as areas for quality improvement, will describe the problem in their own particular language, and will go on to select a methodology with which they feel comfortable. The fact that medical audit this year has been resourced up to eight times more than the corresponding nursing and therapy audit (/48.Om as opposed to C6.2m) leads to the suspicion that the technical-rational, traditional audit approach is favoured more than some other approaches (or, more controversially, that medical audit is more highly valued than other professions' attempts to audit their practice). We can now begin to sense the problems posed for a journal such as this. Do we continue the conspiracy and play by the (medical audit) rules? Or do we begin to bring in a new set of methodologies, with different rules and different techniques? Is there sufficient respect among members of the health care team for the varied contributions we all make in order to expand the perspective and methodologies of audit. Only if this is possible will the objective of this journal be realised and, more importantly, will assessment and improvement of the quality of care become a truly patient focused experience. ALISON KITSON Director Royal College of Nursing Standards of Care Programme Institute of Nursing Radcliffe Infirmary Oxford OX2 6HE