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Beginning in the early 1990s a quality-improvement program began in New York State and has since spread to many other states where report cards were issued to improve cardiac surgery by tracking surgical outcomes, sharing the results with hospitals and the public, and when necessary, placing surgeons or surgical programs on probation. But Sandeep Jauhar writes in the NYT that the report cards have backfired. "They often penalized surgeons, like the senior surgeon at my hospital, who were aggressive about treating very sick patients and thus incurred higher mortality rates," says Jauhar. "When the statistics were publicized, some talented surgeons with higher-than-expected mortality statistics lost their operating privileges, while others, whose risk aversion had earned them lower-than-predicted rates, used the report cards to promote their services in advertisements."
Surveys of cardiac surgeons in The New England Journal of Medicine have confirmed that reports like the Consumer Guide to Coronary Artery Bypass Graft Surgery have limited credibility among cardiovascular specialists, little influence on referral recommendations and may introduce a barrier to care for severely ill patients. According to Jauhar, there is little evidence that the public — as opposed to state agencies and hospitals — pays much attention to surgical report cards anyway. A recent survey found that only 6 percent of patients used such information in making medical decisions. "Surgical report cards are a classic example of how a well-meaning program in medicine can have unintended consequences," concludes Jauhar. "It would appear that doctors, not patients, are the ones focused on doctors' grades — and their focus is distorted and blurry at best."
(Score: 0) by Anonymous Coward on Thursday July 23 2015, @09:48PM
Perhaps a metric that rates surgeons based both on risk level and success rate. But then who's going to determine risk level. I suppose you can introduce certain risk factors such as age and perhaps weight and other factors depending on the type of surgery (ie: does blood pressure affect the likelihood of success for this type of surgery) but even then risk level often depends on many factors that are best applied on a case by case basis. A quantitative set of risk factors needs to be introduced, one that's not subject to qualitative opinions.
(Score: 0) by Anonymous Coward on Friday July 24 2015, @12:03AM
Indeed. The report cards should take into account a number of factors. As you note, the risk factor needs to be cross checked somehow with the success rate. In addition, it seems to me that we should also be looking at patient satisfaction with the care they received. Besides that, these report cards should have some sort of grading by thier peers. In other words, what do their colleagues think of them as doctors? Taken together, I believe that would give a much clearer picture of how these surgeons rate.