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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

#251

Post by aantix »

ItsMe000001 wrote: post #21
slap_shot wrote: post #4

Earlier quoted context omitted.

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 syste…

> ... and colleagues would objectively assign a degree of difficulty score. He asks for a level of "objectivity" that you just can't get. What do you think medicine is? Like repairing toasters? "Why don't you simply assign some objective numbers" - it's so easy! No it is not, unless you only count a set of basic and routine procedures. Even things like a broken bone vary greatly - and then add the additional variance…

The feedback would have to be anonymous. It’s the only way to get honest scoring.

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

#252

Post by ReallyAnonymous »

sharmi wrote: post #78
drewg123 wrote: post #17

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 mont…

I do not intend to diminish the suffering your mother has gone through or, in consequence, your mental agony. I myself have watched a close relative suffer. Treatment that just prolongs the agony is hellish and pointless. Having said that, I just wanted to add a small message of hope for those in similar situations. Atleast in the case of lung cancer, the situation is vastly improved now. The variants of lung cancer…

I've taken care of numerous people living with their lung cancer. It becomes difficult when they develop another cancer, e.g. breast. Do you do axillary dissection or just radiate the axilla? Anyway, melanoma, lymphoma and lung CA (and breast) have seen remarkable improvements in the last 20 years.

When I was an undergraduate I worked in the lab of Dr. Robert Bast to pad my resume - he went on to head cancer research at MD Anderson. He's the doctor that discovered the CA-125 ovarian tumor marker. Anyway, 26 years ago he told me he thought we'd have a cure for cancer in the next 10 years. I think he's off by 40-50, but we are making strides

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

#253

Post by vannevar »

crusso wrote: post #108

Ultimately, 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 article itself alludes to a 'EuroSCORE' that purports to rate the risk of mortality beforehand. It seems like the mortality ratings should be risk-adjusted. A double-blind system as you suggest could work like this: First, the rating system would be opt-in on the part of the participating surgeons. It seems likely that patients would prefer rated surgeons, so there would be an incentive to participate but it would not be mandatory. Those who belonged to the rating body would be required to do anonymous risk assessment on some number of cases per month. They wouldn't know who the patients are or who is treating them, they would only get anonymized records. Their risk assessments would be calibrated in the short run against other assessments, and in the long run against outcomes. These calibrated risk assessments would be used to adjust the score of the treating surgeon on the outcome, so that they would be penalized less for mortality in patients with a very high assessed risk.

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

#254

Post by lucio »

rtkwe wrote: post #136
kazinator wrote: post #44

Earlier quoted context omitted.

Low mortality is a good damned measure. I don't want to be operated on some yahoo surgeon who unconditionally operates regardless of risk and has a high mortality track record as a result.

It becomes a bad measure because once it's a target people start to manipulate it in order to hit the target. In this case if a surgeon refuses to take anything but easy surgeries their stats will look amazing but it says very little about their actual abilities.

but he'll become good at accurately measuring risk, so if accepts to operate on you, you can be certain that your case is simple and your odds of dying on the table are slim.

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

#255

Post by jamaicahest »

brandonmenc wrote: post #114
samfisher83 wrote: post #20

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.

Guarantee QBs are doing everything possible to avoid being sacked, and would gladly give up rating points in exchange for not being hit.

I could say you're wrong, but then it would simply be my opinion vs your opinion, and the discussion would end there.

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

#257

Post by emodendroket »

newfoundglory wrote: post #225
emodendroket wrote: post #186

Earlier quoted context omitted.

I don't see how the analogy works. The entire point is you have a medical record with objective characteristics that can be tied to the risk of any given procedure.

My entire point is that isn't true at all - you have a medical record with some objective characteristics, but it is not possible to calculate the risk of a procedure based on that information. Just like in software, we have a project requirements document with many objective characteristics and we are unable to calculate the time required based on those characteristics.

So what is the risk calculation based on? Presumably the doctors refusing to do procedures they deem high-risk are not determining completely at random. The risk calculation doesn't have to be perfectly accurate, and it seems to me as though heart procedures are better defined than software projects.

(And besides that, although software estimation is notoriously inaccurate, it is still done and written into contracts all the time, because it serves a useful purpose that outweighs its inaccuracy)

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

#258

Post by emodendroket »

daurnimator wrote: post #212
jpatokal wrote: post #172

Earlier quoted context omitted.

One support team I used to work with prioritized "first touch resolution" for email cases as well, so the agents would answer every case with a 16-page DYI flowchart listing every single possible problem and its resolution. KPIs are hard...

That sounds great! I'm reminded of https://xkcd.com/810/

Getting sent the manual doesn't sound that great to me.

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

#259

Post by emodendroket »

ahje wrote: post #242
russjr08 wrote: post #223

Earlier quoted context omitted.

I’ve even heard of some centers that are allowed to hang up on you if you try that.

The call center I used to work for expected us to give one warning for such hostile behavior, and then simply hang up if the customer kept being abusive and/or threatening. In general its, simply a bad idea to be rude to the person you expect to provide assistance.

We didn't have that, but people had figured out a way to use the hardware to hang up and bypass the monitoring and would just use it.
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