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Heart surgeons refuse difficult operations to avoid poor mortality ratings

telegraph.co.uk

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Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#11

Post by bradlys »

firstplacelast wrote: post #3

Check 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…

If you think about what it takes to get into med school then it seems pretty natural that you're going to get hyper competitive surgeons in the end. It starts before med school. You get assigned 10 unobtainable books that only the library has. Finals week comes around, all the books are missing even though they have to stay in the library. Turns out your classmates hid them inside the library so they could have a competitive advantage and get a higher grade on the curve.

You already devoted probably half your life to becoming a surgeon, why would you screw it up and lose so much ground so easily?

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#12

Post by billfruit »

On a related vein, do surgical procedures involve any type of quality control, where the work is independently audited? If so I wasn't aware. Quality control is such an important cogwheel of processes in many other industries, yet I don't hear much talk of it in relation to medical profession.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#13

Post by sky_rw »

aantix wrote: post #2

The 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.

Does the NHS provide enough free market choice that anybody could take advantage of a score even if they wanted to?

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#14

Post by carbocation »

bradlys wrote: post #11
firstplacelast wrote: post #3

Check 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…

If you think about what it takes to get into med school then it seems pretty natural that you're going to get hyper competitive surgeons in the end. It starts before med school. You get assigned 10 unobtainable books that only the library has. Finals week comes around, all the books are missing even though they have to stay in the library. Turns out your classmates hid them inside the library so they could have a com…

What decade are you describing? In my medical school, all of the required material aside from our anatomy textbook was given to us as a PDF or a printout.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#15

Post by maxerickson »

tgraham wrote: post #10

66% 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 h…

A large portion of the people undergoing heart surgeries still face a high risk of death if they don't have the surgery (with the surgery bringing the chance of a longer, more comfortable life).

Here's why your hot take isn't the best take:

“About 30 percent of them said they had turned patients down for surgery even when they knew full well that surgery was in their best interest.”

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#17

Post by drewg123 »

It was not heart surgery, but after being diagnosed with lung cancer, my mother had one of her lungs removed by a surgeon who assured us he'd be able to get all the cancer. She had a miserable, painful recovery that I would not wish on anybody. Within a week or two of her recovering to the point where she could walk short distances, the cancer was found in her other lung and went on to kill her within a few more months. She may have gained several months of life from this operation, but it was a painful few months without dignity.

It was 20 years ago, so my memory is fuzzy, but I don't remember ever being presented with anything but certainty from the surgeon that he could cure her. I think that patients and surgeons need to have a better idea of the realistic chance of success from a major surgery in order to make an informed decision. Perhaps if surgeons at least have to worry about their own numbers, they might hesitate before attempting cases like my mother's.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#18

Post by ZeroGravitas »

tgraham wrote: post #10

66% 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 h…

If they're misleading stats then I'd rather not know them as then I'm going to try to do something stupid as a result.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#19

Post by bradlys »

carbocation wrote: post #14
bradlys wrote: post #11

Earlier quoted context omitted.

If you think about what it takes to get into med school then it seems pretty natural that you're going to get hyper competitive surgeons in the end. It starts before med school. You get assigned 10 unobtainable books that only the library has. Finals week comes around, all the books are missing even though they have to stay in the library. Turns out your classmates hid them inside the library so they could have a com…

What decade are you describing? In my medical school, all of the required material aside from our anatomy textbook was given to us as a PDF or a printout.

This was within the last 7 years. I don't doubt each school is different. This was at UW in Seattle.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#20

Post by samfisher83 »

Sports athletes do this. For example players won't attempt end of the quarter half court shots since that will lower their percentages, or QBs taking sacks to not lower their QB ratings. What they do in sports is keep advanced stats. Instead of just giving a pure mortality rating have mortality rating, by surgery type.
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