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Heart surgeons refuse difficult operations to avoid poor mortality ratings

telegraph.co.uk

71–80 of 274 posts

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

#71

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…

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?

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

#72
post #59

it's been said a few times on /r/medicine, surgeons have their lawyer in mind when operating, they're skilled, but they first avoid anything that could damage their own life irreversably. Of course to an extent this goal aligns with the patient, but not always, and a bit sad on the ideal side.

Can someone really sue their surgeon in the US?

Absolutely. You can sue for pretty much anything. Winning is another story, but doctor's don't generally make sympathetic defendants. Juries know they have money and that they pay huge insurance fees to cover these cases. Of course, after losing a big case where the insurance company pays out millions of dollars, they likely become uninsurable and unemployable. But hey, the money is good until you hit the anti-lottery.

My father was an anesthesiologist (who retired in good standing), and I remember him telling me a case he read about a Caesarean section. The surgeon was using an electrocautery pen to sear closed the ends of blood vessels. The surgeon set down the pen on the surgical cart, lifted the baby out, set the baby on the cart, and the baby's heel touched the pen. Now the baby has a small scar on the bottom of his/her heel for life. The parents sued the surgeon, the cart nurse overseeing the cart, and the anesthesiologist was close to the surgical cart. All 3 defendants settled out of court, since babies almost always win jury cases against rich doctors, regardless of merit.

The litigant's lawyer would almost certainly bring up a below median survival rate as evidence of a pattern of gross incompetence.

Also, of course, in the U.S., I believe only governments are immune to lawsuits (sovereign immunity) without their consent. The courts have consistently ruled that many rights, including the right to sue, cannot be legally waived by contract. In a similar way, if you sell yourself into slavery by entering into a contract that waives your right against unlawful detention, that contract cannot be legally enforced.

My grandfather was an anesthesiologist. My dad was an anesthesiologist (and did well enough on the MCAT to go to med school after 3 years of undergrad... practiced medicine without an undergrad degree... med school is too competitive today to do such a thing). I was a good student: I graduated from MIT. However, my brother and I saw all of the BS and stress (anesthesiologists have a high suicide rate) and constantly rotating sleep/work shifts and both went into engineering.

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

#73
post #30

It's Goodhart's Law in action, this time with deadly consequences: "When a measure becomes a target, it ceases to be a good measure."[a] [a] https://en.wikipedia.org/wiki/Goodhart%27s_law

I'm not so sure Goodhart's Law is correct.

For example, if I target a high win percentage, is win percentage, then, not a good measure?

Mortality rates are a pretty good measure for surgeons.

The problem here is that they are inflating their measure by cherry picking.

edit:

Some measures should be targeted, the problem here is that it is done in an non genuine way

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

#74
post #30

It's Goodhart's Law in action, this time with deadly consequences: "When a measure becomes a target, it ceases to be a good measure."[a] [a] https://en.wikipedia.org/wiki/Goodhart%27s_law

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.

Finger ----------------> Moon

^ You're looking at this.

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

#75
This topic was discussed in the last EconTalk [1] podcast featuring the author of a recent book “The Tyranny of Metrics” [2]. I think one of the author’s interest insights is the distinction between metrics for diagnostics and those for incentives.

1. http://www.econtalk.org/archives/2018/04/_what_is_the_ap.htm...

2. https://www.amazon.com/Tyranny-Metrics-Jerry-Z-Muller-ebook/...

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

#76

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 guess I'm just shocked that the surgeon could offer that level of assurance about something like that.

Unbelievable! The five year survival rate for lung cancer is only 18%! Even when the cancer is localized the five year survival rate is only 55%![1]

It's irresponsible for the doctor to not give a reasonable prognosis!

[1]http://www.lung.org/lung-health-and-diseases/lung-disease-lo...

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

#77
post #30

It's Goodhart's Law in action, this time with deadly consequences: "When a measure becomes a target, it ceases to be a good measure."[a] [a] https://en.wikipedia.org/wiki/Goodhart%27s_law

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.

Then maybe mortality rate should be attributed to doctors not operating as well. Low mortality is a good metric on patients, not doctors.

But on the other hand, I don't want to be treated by a doctor who cares more about his sellable stats than saving lives.

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

#78

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 that are most prevalent now can be managed with oral medication alone and the patients can recover to go on and lead normal lives. This is from experience seeing another close relative suffer terribly from lung cancer (mainly because diagnosis of lung cancer itself is very hard as the symptoms show up very late and can be mistaken for other issues) and has now miraculously recovered and is back onto his normal routine.

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

#79

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.

In the US, if the surgery is in hospital:

- Well-regarded hospitals will vet surgeons before granting privileges.

- Average hospitals give out privileges fairly easily if there are no actions against a person's license.

- There is a "collegial" review of big screw-ups that carry major reputational risk.

- As with any fee-for-service firm, "rainmakers" are highly sought after and get away with more.

- Privileges are difficult to take away once granted. (Have stronger legal protections than academic tenure in some states.)

If the surgery is in an ambulatory surgery center or doctor's office:

Basically anything goes. Ice-pick lobotomies, tonsillectomy mills, boob job factories in strip malls....all have happened in recent US history. About as well-regulated as traveling carnivals.

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

#80
post #59

it's been said a few times on /r/medicine, surgeons have their lawyer in mind when operating, they're skilled, but they first avoid anything that could damage their own life irreversably. Of course to an extent this goal aligns with the patient, but not always, and a bit sad on the ideal side.

Can someone really sue their surgeon in the US?

If you undergo a procedure whereby you could die it doesn't mean every cadaver is a paycheck. It means that if your death is a consequence of negligence or malfeasance that family has a recourse.

This is entirely reasonable and I cannot imagine how you could have a medical system where you can't?

What do you do if your surgeon operates drunk and kills you? Hope that a bunch of other doctors don't close ranks and protect their own at your expense? Why would anyone have any faith in their fellow man. People are terrible.

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