Heart surgeons refuse difficult operations to avoid poor mortality ratings
1–10 of 274 posts
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#2The subjective is always where there is value.
I wish there were surgeons that would accept these challenges and colleagues would objectively assign a degree of difficulty score.
And a site that aggregated such scores. I really don’t care how “friendly” a doctor is - did the get the diagnosis right? Did they improve longevity? Did they improve quality of life?
Not easy to score but what everyone wants to know.
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#3Check out the comments over on /r/medicine and you will likely be horrified. It is career over everything. There was even a thread this week about how you should NEVER correct someone above you (med students should never correct a resident and a resident should never correct an attending).
That mentality is terrible for everyone and every thing, except the physicians' careers.
I don't know if we need to select for better people when admitting them to medical school or if the culture is just completely fucked.
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#4The subjective is always where there is value. I wish there were surgeons that would accept these challenges and colleagues would objectively assign a degree of difficulty score. And a site that aggregated such scores. I really don’t care how “friendly” a doctor is - did the get the diagnosis right? Did they improve longevity? Did they improve quality of life? Not easy to score but what everyone wants to know.
Not sure why this is being downvoted. It’s a legitimate request. I worked for a novel medical device company and we had a lot of surgeons on staff.
While not a product we’d ever build, there was always discussion amongst the doctors of how to better grade physicians and specifically surgeons. The concern is was that a lot, and I mean a LOT, of surgeons were bad at their job. They were always proposing different systems to evaluate surgeons, very close to what you described.
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#5The subjective is always where there is value. I wish there were surgeons that would accept these challenges and colleagues would objectively assign a degree of difficulty score. And a site that aggregated such scores. I really don’t care how “friendly” a doctor is - did the get the diagnosis right? Did they improve longevity? Did they improve quality of life? Not easy to score but what everyone wants to know.
What you're describing is commonly referred to as "propensity weighting." It is a good first step, though most of us think it still doesn't do a sufficient job of accounting for the risk of difficult cases.
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#6Would it be possible to determine a "risk" factor and count that in the mortality ratings, or is this too simple?
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#7Check out the comments over on /r/medicine and you will likely be horrified. It is career over everything. There was even a thread this week about how you should NEVER correct someone above you (med students should never correct a resident and a resident should never correct an attending). That mentality is terrible for everyone and every thing, except the physicians' careers. I don't know if we need to select for be…
Such practices were pervasive in other industries too, including air crews. Thankfully, this has been changing, and shown marked improvement in some cases.
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#8The advent of public reporting of outcomes after intervention for myocardial infarction (heart attack) led to an increase in mortality in Massachusetts and New York.[1]
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#9Check out the comments over on /r/medicine and you will likely be horrified. It is career over everything. There was even a thread this week about how you should NEVER correct someone above you (med students should never correct a resident and a resident should never correct an attending). That mentality is terrible for everyone and every thing, except the physicians' careers. I don't know if we need to select for be…
It’s a tough profession populated with type-a people, paid by insurance companies and beholden to malpractice insurers as well.
As with anything in modern society, bean counters rule and usually drive awful decision making.
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#1066% of 115 specialists polled did not refuse a difficult operation.
33% thought about how it would impact their statistics, or put more generously, thought hard about the probability of the patient surviving presumably quite serious surgery.
Yes mortality is a blunt statistic for a surgeon, but perhaps giving people pause for thought about the odds of success is no bad thing.
Contra point: would you rather not know how many cases your surgeon has done that year, and the issues they have had?