Re­port cards a mine­field

The Weekend Australian - Travel - - Health - From Health cover

first in­tro­duced in New York State in 1991. The data in­cluded the raw mor­tal­ity rate for each doc­tor, ex­pressed as the pro­por­tion of the sur­geon’s pa­tients who died within 30 days of their op­er­a­tion, over the pre­vi­ous three years. The fig­ure was ac­com­pa­nied by a risk-ad­justed rate, in­tended to iron out skew­ing fac­tors such as the ten­dency for very skilled doc­tors to see less straight­for­ward cases in which by their na­ture good out­comes were less likely.

Penn­syl­va­nia and New Jer­sey fol­lowed in 1992, and last year the Bri­tish Health­care Com­mis­sion pub­lished on its web­site sur­vival rates for all UK car­diac sur­geons. The com­mis­sion has flagged ex­pand­ing the re­port cards to other med­i­cal spe­cial­ties.

A key im­pe­tus for the UK re­port cards was a scan­dal over mor­tal­i­ties in Bris­tol, south­west Eng­land, where two pae­di­atric car­diac sur­geons were even­tu­ally found to have death rates for a par­tic­u­lar op­er­a­tion five to six times higher than the na­tional av­er­age.

That scan­dal came to light af­ter anaes­thetist Steve Bolsin re­ported his con­cerns. Now the di­rec­tor of anaes­the­sia and as­so­ci­ate pro­fes­sor of pa­tient safety at Vic­to­ria’s Gee­long Hospi­tal, Bolsin is firmly in favour of re­port cards — and says the pro­fes­sion’s ob­jec­tions to them don’t stack up.

Bet­ter mon­i­tor­ing of death rates would have picked up prob­lems with the mass mur­der­ing Bri­tish GP Harold Shipman, who, Bolsin says, would prob­a­bly only have killed 10 to 12 pa­tients be­fore be­ing de­tected — as op­posed to the 215 he is known to have killed (or up to 400 ac­cord­ing to some es­ti­mates).

‘‘ Cer­tainly my view is that they (re­port cards) are a very good idea for ev­ery­body — all spe­cial­ists in ev­ery area, in­clud­ing GPs,’’ says Bolsin. ‘‘ There are a whole se­ries of mis­lead­ing ar­gu­ments that are put for­ward . . . I think they are a bit of a smoke­screen put up by some of the spe­cial­ist groups. I think they (op­po­nents) are afraid of be­ing judged in­fe­rior, or in some way un­ac­cept­able. ‘‘ But we can’t af­ford not to do some­thing about it. Er­rors in the Amer­i­can health care sys­tem kill more peo­ple than breast can­cer and road traf­fic ac­ci­dents, and there’s no ev­i­dence that Aus­tralia is any safer.’’ Bolsin says we need rou­tine mon­i­tor­ing, ‘‘ and if the pro­fes­sion can’t ac­cept it, it will have to ac­cept that it may need to be im­posed’’.

Like the RACS, the Aus­tralian Med­i­cal As­so­ci­a­tion — the in­dus­trial body rep­re­sent­ing all doc­tors’ groups, not just sur­geons — op­poses re­port cards.

AMA vice-pres­i­dent Gary Speck says ad­just­ing the death rates to take ac­count of skew­ing fac­tors such as pa­tients who are sicker to be­gin with ‘‘ sounds easy . . . but be­lies the dif­fi­culty’’ in­volved.

‘‘ The fact that some­thing is up and run­ning and be­ing used (over­seas) doesn’t mean that it’s use­ful,’’ Speck says. ‘‘ A bet­ter way for peo­ple to choose their sur­geon is in con­sul­ta­tion with their fam­ily doc­tor, who will have good feed­back about how pa­tients have done (with par­tic­u­lar sur­geons).’’

Card sup­porter: Justin Oak­ley says some method of re­port­ing is nec­es­sary, be­cause sur­geons vary widely in abil­ity

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