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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: 3, Interesting) by Francis on Thursday July 23 2015, @10:48PM
And it works until it doesn't work. Medicine is a good example of a group of professionals that need some outside intervention. There's a ton of group-think and if you don't go along with the group-think you can lose your license, regardless of whether the group is right. In some cases that even means harmful treatments and refusing to admit that a treatment isn't likely to work. For years they were preaching all sorts of bullshit about low cholesterol diets even though there was precious little evidence that the absolute cholesterol levels played any part in cardiovascular disease.
I'm not sure what the alternative is, but internal standards work best for things like plumbers and electricians where the systems that you're working on are more consistent. Even the most poorly wired house can be fixed by removing the wiring and starting over. Or in less drastic cases rewiring one circuit or another. But, when doctors have a patient that isn't responding in the normal way, there's not really any way of ever pinning it down entirely.
(Score: 2) by aristarchus on Friday July 24 2015, @12:00AM
For years they were preaching all sorts of bullshit about low cholesterol diets even though there was precious little evidence that the absolute cholesterol levels played any part in cardiovascular disease.
Thank you for your professional opinion! Where did you intern and do your residency?
The point is not that the system of professions works until it doesn't work, the point is that all external attempts to "fix" a profession do not work, either, since the reformers have no idea what they are doing. Usually such persons are called "managers".
(Score: 0) by Anonymous Coward on Friday July 24 2015, @12:42AM
Hoo, boy! May you be cursed with taking the medicine you prescribe to the rest of the world. Trust me, it isn't so fun when you have a loved one in the ICU and a young resident doctor takes it upon himself (sometimes against the expressed wishes of the patient's family) to do all sorts of uncomfortable treatments which will only prolong the agony on the way to the inevitable. "It is for their own good, you see; unfortunately, most patients are just too ignorant to realize it." All too often doctors just don't want to be bothered explaining to that "ignoramus patient and their kooky family" why this treatment is necessary. They are professionals, you see, and they don't tolerate too well when their patients begin to second guess them. Under those circumstances, you begin to see in stark relief why the needs and wishes of the patient really do need to be taken into account. No, the solution is not to turn this completely over to outside "reformers". But, equally, allowing the surgeons to operate (heh) completely inside the echo chamber without any feedback from the outside world is not the solution either.
(Score: 3, Insightful) by Francis on Friday July 24 2015, @02:55AM
Precisely. The point isn't to take away these decisions from the medical community, merely to realize that MDs are not scientists and they need help reading, understanding and conducting research. There also needs to be some consideration paid to the patients that aren't getting any better or have their own wishes that may not be medically advisable. It's not fun getting ineffective treatments because the doctor refuses to admit that the problem might be something else. Thankfully in the age of the internet it's easier to find other possible treatments.
Unfortunately, the internet is also a good source of dangerous and misleading advice.
(Score: 2) by aristarchus on Friday July 24 2015, @03:12AM
you begin to see in stark relief why the needs and wishes of the patient really do need to be taken into account.
Well, no, you ignoramous! Do you have any idea of what is medically possible? No, you do not. That is why you seek the expertise of a professional. Do you disagree with your professional? You are welcome to refuse professional advice, take your family member home to die in the manner you see fit. But do not pretend that the professional is somehow exercising force majure over you, unless, of course, you pose a threat to public health. Point is, for any profession, whether it be law, medicine, academia, engineering, or even the clergy, you do not hire them to do what you want done, you hire them to tell you what you should do, based on their expertise. If you want to go the the faith-healer, homeopath, or Congress, that is your choice. But any functional profession has reasons based on knowledge and experience, and these will (or should!) be a consensus across the profession. This is why rabid religious people cannot be doctors. Or pharmacists. Or, evidently, cake bakers. But they can, as any client or patient, walk away and take their chances with ignorance. Again, simply: the public is not competent to judge professions.
I am getting the idea that I may have been too harsh here, and apologize if you have actually had a bad experience. Such things do happen. But they would be much, much worse if medical decisions where made by bean-counters and angie's list.
(Score: 1, Interesting) by Anonymous Coward on Friday July 24 2015, @04:33PM
Next time, dork, actually read what I wrote and respond to that. It will help facilitate a genuine discussion and exchange of ideas, rather than just talking past me.
Now, on to a real discussion:
On this much we agree.
Actually, sometimes doctors do, in fact, (try to) make unilateral decisions about their patient's care. It happens a lot more than you probably realize. Apparently, explaining the therapies that they prescribe is too time consuming to bother.
Again, on this much, we agree. What needs to be added is that these professionals are not exempt from explaining those reasons to the people under their care. In addition, the patient needs to have the final say in what treatment they receive.
Irony, thy name is aristarchus! You sound just as rabid as any religious fanatic. You might want to reflect on the thought that there are many, many Christian doctors and pharmacists out there. I personally know at least a few. It wouldn't surprise me in the least that you have entrusted your care (and the care of your family) to at least a couple of those "rabid religious people".
And the simple point you have overlooked is that doctors are not omniscient. There are a whole lot of reasons why someone might want to refuse medical treatment. Some of those reasons may be good reasons. Some, less so. But the patient needs to be given the final say in their own treatment. Anything less is to deny the patient's humanity. Clear now?