Work Of Medical Professionals Research Articles

Clinical analysis of Marchiafava-Bignami disease

BackgroundMarchiafava-Bignami disease (MBD) is an exceptionally rare condition, a fact that should pique the professional curiosity of medical practitioners. In recent years, case reports of this disease have been infrequent, and no comprehensive analysis or summary of the characteristics of the published cases has been conducted.MethodsWe collected the medical records of three patients treated at our hospital from March 2022 to March 2023. Furthermore, we searched PubMed for “case reports” from January 2017 to March 2023 and included 30 cases. By retrospectively analyzing these 33 cases, we summarized the characteristics of the disease.ResultsBased on our analysis, we found that MBD primarily affects middle-aged men and typically has an acute or subacute onset, with the primary clinical manifestations being disturbances of consciousness, speech disorders, cognitive impairment, and psychiatric or behavioral abnormalities, often leading to misdiagnosis of psychiatric disorders. Most patients have a history of alcohol consumption or malnutrition. Head CT or MRI revealed symmetric lesions in the corpus callosum, with the splenium being the most commonly affected area. Lesions might also involve white matter outside the corpus callosum, and a wider range of lesions suggested a poor prognosis. However, the prognosis is generally favorable with timely and adequate administration of B vitamins, providing reassurance to medical professionals and patients alike.ConclusionThe early recognition and treatment of Marchiafava-Bignami disease are paramount, as they can significantly improve the prognosis. This underscores the critical need for prompt clinical intervention in the early stages of the disease, instilling a sense of urgency and significance in the work of medical professionals.

Budućnost trijaže

Introduction. Triage is the assessment of the patient’s condition in order to determine the urgency of treatment. It is usually performed by a nurse, often using a five-level protocol.Aim. To conduct a comparative analysis of the accuracy of categorization and diagnosis between ChatGPT (a chatbot which uses machine learning algorithms) and traditional medical triage, as well as to provide recommendations on how artificial intelligence can improve the work of medical professionals in patient triage.Methods. The literature selected for comparison is “Emergency Nursing: 5-Tier Triage Protocols”. The most common diagnoses for which patients present to the emergency department were selected for research. Then, triage categories were selected and case presentations were created. These cases were presented to ChatGPT, and its responses were comparedwith the literature.Results. ChatGPT correctly categorizes triage cases in 43.33% of cases, with an average category difference of 0.7. Although it made mistakes in 1 or 2 categories in some cases, it assigned diagnoses to a higher category for patient safety.Discussion. Comparison with other studies shows that errors occur in up to 40% of nurse decisions due to various factors such as inexperience, speed of work, and a large number of patients, which could be reduced by additional artificial intelligence assistance. It is necessary to take into account factors that artificial intelligence cannot take over and that it can only be a help, not a substitute for medical personnel.Conclusion. ChatGPT has potential for usage in medical triage, but with improvements in specialized training of models on medical data and terminology to improve the accuracy and reliability of the model.

Evaluation of family physicians’ attitude towards primary healthcare consultations

Abstract Background The quality of services in the health care system is very important for both patients’ health and health care providers. In the past decade, good service ratings from the patient's perspective have become crucial in evaluating the work of medical professionals and health care institutions. However, it is also important to consider the opinions of health care specialists, especially when it comes to medical consultation, which is one of the most important components of primary health care (PHC) chain. Aim To evaluate the attitude of family physicians (FP) towards consultations provided in PHC. Methods The study was conducted in 2022. December - 2023 in February. The research contingent is FP of Lithuania. Research method - quantitative momentary research, anonymous questionnaire survey, 206 subjects were interviewed. Calculated chi-square (χ2) and z-criterion. Results The majority of FP indicated that they involve the patient in the decision-making process (68.0%), those working in private institutions said so more often than those working in public institutions (p < 0.05). 89.3% of the subjects stated that the consultation time with the patient is not enough, and 70.4% respondents receive many unregistered patient visits per day. E-health makes it difficult for 81.1%, 86.4% of the respondents indicated that there is too much of a workload and this was mostly said by respondents working in public institutions (p < 0.05). Remote consultations facilitate the workflow (76.2%). The older age of the respondents and greater work experience lead to lower self-confidence during remote consultation, longer consultation time and less belief in the benefits of remote consultation (p < 0.05). Conclusions Most FP positively evaluate the consultation they provide, but they also said that the consultation time is insufficient, they must consult a number of unregistered patients, e-health complicates the work. Remote consultations facilitate the workflow. Key messages • The consultation time is insufficient. • Remote consultations facilitate the workflow.

DRUG INTERFERENCE IN LABORATOTY TESTS

Drug Laboratory Tests Interference (DLTI) is currently considered one of the important problems of medicine. The ability of drugs to affect metabolism, displace endogenous and exogenous substances from bonds, interfere with chemical reactions during laboratory research can lead to false-positive or false-negative results, and as a result of incorrectly established diagnosis, incorrect therapy and deterioration of the patient’s condition.
 To highlight the problem of DLTI, summarize the information obtained from scientific sources for workers in the medical field.
 Medicines can affect the results of laboratory tests through technological or pharmacological (physiological) interference. Predicting DLTI is substantially difficult, since the sources of information on pharmacological interference consist mainly of instructions for medical use of drugs, for analytical - spontaneous reports. Very often, the information is fragmentary, insufficiently documented, and contradictory. In order to avoid diagnostic errors as much as possible, medical workers need to strictly follow the recommendations regarding the pre-analytical stage, emphasize to the laboratory workers what medicines the patient is taking. In order to facilitate the work of medical professionals in various countries, electronic databases with checked information about DLTI are being developed. However, in order to refer to the above databases, a medical professional must have a suspicion of a possible drug interaction with laboratory tests. Decision support programs are recommended to be developed and implemented to automate DLTI reporting.

МЕТОДИКА ОЦЕНКИ МЕДИЦИНСКИХ РАБОТНИКОВ ПРИ ПРОХОЖДЕНИИ АТТЕСТАЦИИ ДЛЯ ПОЛУЧЕНИЯ КВАЛИФИКАЦИОННОЙ КАТЕГОРИИ ПО СПЕЦИАЛЬНОСТИ «ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ И ОБЩЕСТВЕННОЕ ЗДОРОВЬЕ»

Significance. Specifics of the work of medical professionals in some specialties are not accounted for by legally mandated requirements for certified specialists. It is necessary to specify methodology for certifying specialists for each of the approved nomenclature of medical specialties, including “Health Organization and Public Health” in order to improve performance efficiency of attestation commissions. The purpose of the study is to develop methodology for certifying health professionals with "Healthcare organization and public health" qualification category. Material and methods. The methodological basis of the study is presented by regulatory information analysis, and the method of expert assessments. Results. Based on the results of the analysis of normative legal documents and available literature, a methodology was developed to certify health specialists with "Health Organization and Public Health" qualification category. Within the framework of this methodology, the main and additional criteria that are potentially applicable for certifying specialists in health organization and public health were identified, and an evaluation gradation of these criteria was developed. The opinion of 35 specialists with at least a five-year experience in health organization collected through a specially designed questionnaire were analyzed using the expert assessment method. The experts were asked to evaluate the methodology for certifying health specialists for "Health organization and public health" qualification category identifying significance of individual criteria on a rank scale from 1 to 6 and grading their values according to the qualification category. In general, the experts' opinion coincides with the proposed methodology. Based on the results of the expert evaluation, the most significant criteria have been highlighted. Conclusion. The methodology for certifying health specialists with "Health organization and public health" qualification category is based on current normative and legal acts and makes it possible to subjectively certify a specialist with the relevant qualification category. A further opinion evaluation of specialists in health organization is needed to decide on the feasibility of using the developed methodology for certifying medical specialist with “Health Organization and Public Health” qualification category. Scope of application. The study results can be used by certification commissions for attesting medical specialists for "Health organization and public health" qualification category.

Evidence-Based Nursing Practices for the Prevention of Newborn Procedural Pain in Neonatal Intensive Therapy-An Exploratory Study.

Background: Due to the progress in neonatology, in particular, in the past three decades, the mortality rate among patients of intensive care units has decreased. However, this is connected not only with newborns needing to stay longer in the unit, but also with the exposure of newborns to many painful procedures and stresses. Lack of or insufficient pain prevention has a negative impact on the sensory or locomotor development of newborns. Despite the presence of guidelines based on scientific evidence, the use of pharmacological and non-pharmacological pain-management methods in newborns is still insufficient. Aim: The aim of the study was to: identify the knowledge nurses/midwives have of recommended non-pharmacological and/or pharmacological methods, in particular, in relation to medical intervention procedures; assess the interventions for pain relief applied by midwives/nurses most often in their clinical practice; examine the role of age, general work experience, education level and years of work of medical professionals on a neonatal ward, as well as the referral level of a unit, versus the application of pharmacological and non-pharmacological methods. Methods: A descriptive and quantitative study conducted in 2019 among Polish nurses/midwives working at neonatal intensive care units. Results: The analysis of the material reflected the deficit of knowledge and the insufficient daily use of recommended pain-relief measures among the respondents. Conclusions: The interpretation of data indicates that despite the clear and easily available recommendations of scientific societies concerning the mode of conduct in particular medical procedures, medical personnel do not apply those recommendations in their everyday practice. It is necessary to plan and implement education strategies for nurses/midwives on standard pain-management interventions during painful medical procedures.

Industry 5.0 in Orthopaedics.

Industrial revolutions play a major role in the development of technologies in various fields. Currently, the world is marching towards softwarization and digitalization. There is an emerging need for conversion of Industry 4.0 to Industry 5.0 for technological development and implementation of the same in the digital era. In health care, digitalization emerged in Industry 4.0 revolution. To enhance patient care and quality of life, Industry 5.0 plays a major role in providing patient-centric care and customization and personalization of products. The integration of human intelligence with artificial intelligence provides a precise diagnosis and enhances the recovery and functional outcome of the patients. In this manuscript, the domains and limitations of Industry 5.0 and further research on Industry 6.0 were elaborated on to bring out technologies in better health care. Industry 5.0 lessens the work of medical professionals and integrates software-based diagnosis and management. It provides cost-effective manufacturing solutions with limited resources compared to Industry 4.0. Industry 5.0 focuses on SMART and additive manufacturing of implants, and the development of bio-scaffolds, prosthetics, and instruments. In this manuscript, the domains and limitations of Industry 5.0 and further research on Industry 6.0 were elaborated on to bring out technologies in better health care. 'The personalization and customization of products' are the hallmarks of this evolving Industry 5.0 revolution. The major uplifts in various domains of industry 5.0 such as advanced automation, digitalization, collaborative robots, and personalization bring this an inevitable mechano-scientific technological revolution in this current medical era.

Problems of organizing the work of pathological and anatomical bureau (devices), forensic medical examination bureau in the conditions of COVID-19

The work of medical professionals is always associated with a risk to life, but during the onset of the COVID-19 pandemic, forensic experts and pathologists were faced with the need to diagnose a new and highly contagious disease in the presence of inadequate specific methodological guidelines.
 Optimization of work organization processes, analysis of risk factors for the spread of COVID-19 infection in pathological and anatomical bureaus (departments) and forensic medical examination bureaus is an urgent task of public health. Forensic pathologists and pathologists are among the most vulnerable groups of healthcare workers exposed to the risk of infection in the workplace during epidemics, pandemics, and in high-risk conditions when emerging infections such as COVID-19 coronavirus.
 The purpose of the study was to analyze and identify the problems of organizing the work of persons involved in forensic medical examinations, post-mortem examinations in the context of the COVID-19 coronavirus.
 The study showed that the existing regulatory organization of the work of persons involved in the conduct of forensic medical examinations, post-mortem examinations does not allow to fully ensure the structural and procedural factors that regulate the activities of the personnel of pathological bureaus (departments) and forensic medical examination bureaus under the risk of coronavirus infection COVID-19.

Особенности профессионального выгорания медицинских работников

The research purpose is to study professional burnout in a medical organization. Materials and methods. Information was collected using a modified questionnaire of the pilot survey “Influence of behavioral factors on human health”, as well as a Maslach Burnout Inventory adapted for medical professionals. Results. According to the Maslach Burnout Inventory adapted for medical workers, the level of emotional exhaustion was 28 points (high level). The average arithmetic result on the depersonalization scale was 10 points (average level). On the scale of reduction of professional achievements, the average score was 31 points (low level). Conclusion. Professional burnout is part of the work of medical professionals. It begins to form at the student age and continues to progress throughout his career. According to statistical studies, professional burnout leads to a decrease in the quality of medical care and increases the number of medical errors.

Information System for Integrated Medical Records with Access via IOT Technology

The objective of this project was the development of an information management system for healthcare purpose using cloud computing and IoT technology. The system was designed to receive data coming from medical instruments, as well as documents issued by healthcare professionals and doctor responsible for the care of a patient. For medical consultation, patients must use an identification card that allows access to the corresponding medical history stored in the cloud. This access can be done through an RFID reader, making it possible to consult patient information on a human-machine interface, where new information can also be registered. For the development of the interface, an application for the Android operating system was created, where information can be accessed, and documents can be stored. Storage was implemented on Google's Firebase® platform. Akyiama's RFID reader integrated in a Raspberry Pi was used to access the information. Exemplifying the connection with biomedical instruments, a sen-11574 heart beats sensor was connected to a Raspberry Pi, whose measurements were converted to the I2C format with an ADS-1115 module. Results obtained are very promising to be applied in the automation of hospitals, first aid and private assistance in medical offices. the main benefit for patients is the fact that they can keep their medical history in the cloud, which can prevent loss of patient information in usual cases such as changing doctors, offices, or hospitals, which is commonly the case. Therefore, the system allows the preservation of the patient's historical record. The medical care system would make it more effective as it facilitates the work of medical professionals and assists in the patient's day-to-day life with updated health information

The cost of cybercrime in the US healthcare sector

The US healthcare system is burdened with the highest costs in the world, and they are still rising as a result of the system itself, its own inefficiencies and government politics. However, there is yet another factor coming more and more into play, adding additional costs and risks to stakeholders in the healthcare system, affecting patients, employees, governments and the doctors themselves. While digitisation and technology provide vast benefits for the quality and efficiency of the work of medical professionals and care of patients, cybercrime in the healthcare sector has risen as well.

Analysis of the state and problems for implementing government programs on drug availability based on questioning of medical professionals

Reformatting of the healthcare system in Ukraine and around the world becomes increasingly important due to the introduction of modern information and medical technologies. Providing affordable, safe and quality care to patients suffering from socially important pathologies becomes more significant due to lack of budget funds. Developed countries are trying to compensate patients for access to medicines by implementing government drug reimbursement programs. One of the main problems in the implementation of government programs is the lack of proper feedback between public authorities and medical professionals directly involved in these programs, and it has a negative impact on future activities.Aim. To assess the current state and identify problems in the implementation of government programs regarding the availability of medicines based on the results of a questionnaire survey of medical professionals.Materials and methods. Scientific publications of domestic and foreign authors, data from official sites on profile subjects were used in the research. The analysis was performed using statistical methods, questionnaires, as well as methods of generalization and comparison.Results. By processing literature sources on selected topics, in particular for providing medical and pharmaceutical care to patients around the world, the problems faced by health professionals when working on government programs in healthcare were identified. The analysis of the results of a questionnaire survey of medical professionals participating in the government program “Аvailable medicines” was conducted; it allowed to assess the situation and identify problems in its implementation, as well as to propose the main areas for improvement.Conclusions. The study has allowed us to identify the current state and key issues, as well as areas for improving the work of medical professionals in the implementation of government programs on the availability of medicines.

The intersubjective accomplishment of power by medical professionals within unregulated combat sports

The lack of power experienced by medical professionals working in various sport settings has been consistently evidenced by sociologists researching the provision of medical care to athletes. In this paper, which focuses on the work of medical professionals within unregulated combat sports in England, we extend this discussion by focusing on the means by which such professionals attempt to (re)construct power within contexts where it cannot be taken for granted. To explore this issue, we conducted 200 hours of observational fieldwork at competitive combat sports events, along with interviews with 25 medical professionals with experience in this field, 7 combat sports referees and 9 event promoters and their staff. Employing the concept of power as ‘intersubjective accomplishment’, we argue that the influence necessary for medical professionals to undertake their work must be actively won within specific situations, principally relying on their ability to tactically interact with various other people. In so doing, we evidence both successes and failures of medical staff in this respect, arguing that such informal means of securing power make caring for the health of combat athletes a challenging proposition.

(Re)descriptions of medical professional work: exploring accounting as a performative device within an emergency unit health-care context

PurposeThis article addresses issues of calculation and economization in contemporary public organizations. In particular, it investigates how choices of organizing emergency health-care have been affected by accounting as a performative device. Special attention has been paid to how accounting brings about performative consequences in shaping the medical profession and its context.Design/methodology/approachThe article employs qualitative research methods and draws its analysis on empirical data from in-depth interviews at an emergency health-care unit in Sweden.FindingsIt is demonstrated how accounting, in the form of calculations of treatment time and number of patients, enables performative consequences for medical professional work. It is also demonstrated how the use of accounting engages (re)descriptions of practices and roles, creates accounts of patients, and helps to sustain such (re)descriptions. Accounting terms (such as efficiency and control) have been reframed into medical terminology (such as health-care quality and security), ensuring and retaining (re)described medical professional work in terms of practices and emerging roles.Originality/valueThis article contributes to (1) the literature on accounting practices within health-care contexts by demonstrating a case where the accounting ideas and practices of medical professionals are coexistent and interwoven and (2) the increasing body of literature focusing on accountingization by showing how emerging calculative technologies carry performative power over medical professional work through formative (re)descriptions.

Legal responsibility for infringements related to providing medical assistance and services

The purpose of the paper is to investigate legal liability for offenses related to the provision of medical assistance and services. Research methods: documentary analysis and synthesis, comparative analysis, objective truth, cognitive-analytical, etc. The main types of legal liability for offenses in the sphere of medical services and services were investigated, in particular: the grounds for the application of civil, disciplinary, administrative and criminal liability were revealed. The development of medical science, the improvement of the standard of living of the population and the establishment of democratic institutions help to increase the demands on the work of medical professionals and to increase the cases of their responsibility for the improper performance of their professional duties. The specificity of the legal liability of medical professionals and medical institutions is the problem of the not legally fixed concept of medical error (which is considered to be a purely medical concept, but is nonetheless a ground for exemption from legal liability) and an accident. When considering medical cases, the court is always forced to establish the absence or presence of guilt in the actions of medical professionals, and the presence of a medical error or accident precludes the liability of medical professionals. Therefore, defining the boundaries of a medical error and an accident is a top priority. Therefore, it is necessary to distinguish concepts such as medical error, accident and professional misconduct in medical practice. In this case, a medical error should be understood as legitimate actions of medical professionals. It should also be noted that it is worthwhile to take advantage of the experience of many countries and to introduce a professional error insurance institution that results in harm or loss to the health of a citizen unrelated to the negligent or negligent performance of their professional duties. However, in legal practice, it is necessary to refuse to use the term medical error, and to speak only about professional or medical error.

Seriously Foolish and Foolishly Serious: The Art and Practice of Clowning in Children's Rehabilitation.

This paper interrogates and reclaims clown practices in children's rehabilitation as 'foolish.' Attempts to legitimize and 'take seriously' clown practices in the health sciences frame the work of clowns as secondary to the 'real' work of medical professionals and diminish the ways clowns support emotional vulnerability and bravery with a willingness to fail and be ridiculous as fundamental to their work. Narrow conceptualizations of clown practices in hospitals as only happy and funny overlook the ways clowns also routinely engage with sadness, despair, discomfort and many other ways of being and doing. Our exploration of clown practices as foolish exposes the ways children's rehabilitation upholds particular neoliberal models of success and invites a re-centring of rehabilitation and health care research and practice towards relationship building, supporting meaningful projects and a continued nurturing of aesthetic and pleasurable ways of being-in-the-world in the present moment as valuable unto themselves.

Revisiting Medicalization: A Critique of the Assumptions of What Counts As Medical Knowledge

The concept of medicalization is hugely influential and empirical studies have demonstrated that medicalization has largely been achieved through the work of medical professionals or scientists, but also increasingly through the efforts of patients or citizens seeking to legitimize their distress through defining it as a ‘medical’ problem. In this article, I argue that the concept of medicalization is still fundamentally important to the sub-discipline of medical sociology, but that there is a need to revisit and critique its conceptualization. I draw on reflexive arguments within the literature that we, as sociologists, have tended to reproduce the assumptions of the medical profession about what counts as medical knowledge and practice, and on literature that explores the complex and plural ways in which people seek to make sense of their illnesses. I argue that there have been few attempts to engage with the question of how ‘making things medical’ occurs in a global context of medical pluralism. By revisiting Conrad’s approach to defining medicalization, I argue for a separation between empirical observations of the dominance of biomedical knowledge, from theoretical observations about medical knowledge and definitions. I argue for a ‘knowledge-based’ approach to medicalization by opening up the definition of ‘making things medical’ to include all forms of medical knowledge in a global society. The concept of medicalization can then be replaced with medicalizations (plural). To argue this, I take two steps: first, I draw on hermeneutic philosophy to argue that there is a stable definition of medicine on which to base an argument that apparently diverse forms of medical practice can be grouped together and used within the concept of medicalization; second, I argue that medicalization is not unproblematically linked to medical social control. The ‘success’ or not of different attempts to define things as medical problems in part depends on the social and political context. This new approach allows sociologists to make sense theoretically of differences we see in comparative empirical research between whether ‘diseases’ are acknowledged in different national or cultural context. Finally, I provide the readers with guidance on the operationalization of this concept in empirical study.

Medical leaders or masters?-A systematic review of medical leadership in hospital settings.

Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal–and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal ‘leaders’ in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care.

Study of legal framework of involvement of nurses in the process of patient`s informed consent in the republic of Bulgaria and other countries

Introduction: Essential in providing medical assistance to patients is achieving clarity and legal certainty in the work of medical professionals. To this end, a clear and uniform approach in regulation of involvement of nurses in the process of patient’s informed consent, which is currently lacking in the legislation of the Republic of Bulgaria, is to be adopted. Objective: To examine the legal framework of the involvement of nurses in the process of patients’ informed consent in the Republic of Bulgaria and other countries. Materials and methods: We have applied a documentary method. A comparative legal analysis of the legislation on the involvement of nurses in the process of patients’ informed consent in the Republic of Bulgaria and other countries within the period January 2014 – May 2015 has been made. Deliverables: Based on the comparative legal analysis of the legislation of the Republic of Bulgaria and the countries studied, it was found that there is no single approach to the regulations of the involvement of nurses in the process of patients’ informed consent in the country unlike the laws of other countries where it is clearly and systematically arranged. Discussion: In the laws that have been reviewed the liability to inform patients lies on all health professionals. According to the analyzed legal definitions in the legal sources compared, a nurse is a health professional and as such, she has certain obligations in the process of informed consent of patients. Conclusion: It is necessary the current Bulgarian legislation on the involvement of nurses in the process of patients’ informed consent to be further developed and refined taking into account the experience of other countries.

Doctors under the microscope: the birth of medical audit

In 1989 a UK government White Paper introduced medical audit as a comprehensive and statutory system of assessment and improvement in quality of care in hospitals. A considerable body of research has described the evolution of medical audit in terms of a struggle between doctors and National Health Service managers over control of quality assurance. In this paper we examine the emergence of medical audit from 1910 to the early 1950s, with a particular focus on the pioneering work of the American surgeons Codman, MacEachern and Ponton. It is contended that medical professionals initially created medical audit in order to articulate a suitable methodology for assessing individual and organisational performance. Rather than a means of protecting the medical profession from public scrutiny, medical auditing was conceived and operationalised as a managerial tool for fostering the active engagement of senior hospital managers and discharging public accountability. These early debates reveal how accounting was implicated in the development of a system for monitoring and improving the work of medical professionals, advancing the quality of hospital care, and was advocated in ways, which included rather than excluded managers.