Thursday, 25 November 2010


BBC News - Boost for UK over heart surgery performance
This is obviously a good news story - how can it be otherwise. For months, we have been told how poor cancer outcomes are in the UK compared to Europe (which they incidentally are!) Now, here is something we're better at (which we incidentally are!)
There is however a disingenuous spin to the story and how it is being reported. It suggests the reason English heart surgeons have better survival than their European counterparts is because their outcomes are publicly reported. Well what tosh. Public reporting of individual surgeons' outcomes is hugely controversial. Cardiac surgeons were sort of bounced into it . For years after the Bristol Children Heart Surgery tragedy we were the whipping boys of the government and the press and it was inevitable that our outcomes would eventually get reported. As a cardiac surgeon, I am very much in favour of outcome reporting. It is only fair that patients who will be going through what would be the toughest and most dangerous period of their lives need to have some idea of what to expect. Whilst outcomes from institutions are fair game for reporting, I believe that reporting of outcomes/results of individual surgeons is wrong because of 2 simple reasons. Firstly contrary to popular myth, cardiac surgeons are human and the most human of reactions to increased death rates is to avoid operating on patients who you might think have a higher than average chance of dying - i.e. risk averse behaviour. The spin meisters will tell you that does not occur - well if you believe that you'll believe anything!
The second reason why reporting of individual surgeons' outcomes is unfair is because there are many people apart from the named surgeon who contribute to a successful or unsuccessful outcome - anaesthesiologists, nurses, etc. So why should you as the surgeon take the rap for the deeds of your anesthesiologist, Dr. Shipman! We are always being encouraged to work in teams and reporting of individual doctors' outcomes mitigates against that. It is not surprising that despite the efforts of many, reporting of outcomes of institutions and/or individuals has not really spread beyond cardiac surgery in the UK.
If somebody shows me evidence that before public reporting, outcomes in England were worse than they were in the rest of Europe, then maybe (and only maybe) I would be inclined to believe in the spin of the article. This report does not provide that evidence.
Outcomes after heart surgery are better in the UK than in Europe and probably have always been. There are a LARGE number of reasons why this may be so - maybe better trained surgeons, better anesthesiologists, better processes to ensure patients are taking the right drugs etc etc. Whatever the reasons for better outcomes are,  public reporting of them is not one of them.