You cannot compare crude outcomes. You have to adjust for so called "case-mix". For mortality after cardiac surgery, the risk can be calculated using the EuroSCORE II. http://www.euroscore.org/calc.html And even then, often the numbers for individual surgeons are too small to draw conclusions.
Heart surgeons refuse difficult operations to avoid poor mortality ratings
151–160 of 274 posts
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#152A colleague of mine was interviewed by a new hospital heart program. He was asked what his mortality rate was. He replied, what do you want it to be?
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#153Ultimately, we need to compare apples to apples by building rating systems that account for the difficulty of treating patients with various, ailments at various ages, with various complications. Think of it in terms of competitive diving, gymnastics, or snowboarding: Your scores depend upon the difficulty of the moves you attempted combined with your performance of those specific moves. The more difficult the move,…
The "objective metrics" part is key. Medical records are generally written in a way that weaves a standard narrative of the doctor as either a hero/savior or a valiant defender of a lost cause.
Doctors only get investigated when derogatory facts accumulate to an extent that this "standard narrative" collapses. It's not really an objective or scientific standard.
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#154Earlier quoted context omitted.
Sadly, it seems that your mother would not have had a better outcome with or without the surgery - if the doctor had said "I'm 75% sure that the cancer is contained in the one lung, so removing the lung will remove the cancer", would that have changed the decision to have the surgery? What it was was 50%? What is the threshold where someone with a fatal illness will accept the risk for a possible cure?
Perhaps the patient should have the right to decide what that threshold is for themselves rather than having the information hidden from them.
It’s a known Freakonomics effect that doctors treat themselves much less in case of cancer. They don’t want to just prolong their life if it’s only going to be painful longer, because they know the probabilities and the outcomes better.
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#155I firmly believe that this is why my mother-in-law died. She needed surgery to fix a hernia that basically left her unable to eat at all. Is she did not have the surgery she was going to die. The surgeon stopped the surgery because the 'risk' was too high.
48 hours later she was dead.
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#156Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#157Earlier quoted context omitted.
the problem here is that mortality rate is not correlated/normalized with the patient risk factor. the problem lies in the performance indicator itself, not strictly people trying to optimizing for what they are asked for. it is likely inhumane to refuse patients that have slightly above average risk - even if there are some considerations to be had, like having replacement organs go to waste, but that is already cov…
I'm not an expert in cardiatric medicine or anything, but couldn't patient risk be determined by objective factors like patient age and history of previous heart issues?
This is like asking why software project estimation can't just be done by looking at the size of the project to be built.
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#158This isn't surprising because humans will do what they're incentivized to do (speaking mainly in a professional setting here).
Might be effective to add a measure to the transparency that shows something to the effect of, "likelihood to perform life-saving and risky procedures." Therefore a high win-loss with a lower risk threshold would be weighted lower than a so-so win-loss with a higher risk threshold.
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#159There might be several decent ways to improve (at least as a next step) to avoid this particular way to game the KPIs:
- use an assessed upfront difficulty (if available in measurable form) to adjust for the outcome rating
- add additional KPI for % of refused operations (perhaps again adjusted for difficulty)
Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings
#160Earlier quoted context omitted.
Perhaps the patient should have the right to decide what that threshold is for themselves rather than having the information hidden from them.
What information? Apparently the doctor told them he could do it. If he really believed in himself, then he told the patient everything she needed to know. Remember, the other option is "go die". So assigning a percentage chance on the successful outcome of a surgery is utterly meaningless when the alternative is a 100% "go die".
That's not true at all. Would you want to have surgery done if it had a guaranteed 3 month recovery period of incredible pain, a 5% chance of curing you, and a 95% chance of doing nothing, when your alternative is "nothing will hurt, but in 12 months you'll drop dead"?