Your Ideal Surgeon?

Does It Matter If Your Neurosurgeon Is A Jerk? onforb.es/QZPeS4 The point of the WHO briefing is to ensure no-one acts like a jerk
— Norman Briffa MD(@Chestcracker) September 10, 2012

I recently tweeted about an article that I read in Forbes journal on whether the character of an operating surgeon matters to patients.

Which surgeons are the safest?

A study in France looking at the effect of surgeon age on outcomes after thyroidectomy has received world wide coverage this past week.
It is an interesting topic and very relevant to my specialty of cardiac surgery. To be a perfect cardiac surgeon requires qualities that probably peak at different ages - stamina, patience, clinical judgement and wisdom, as well as surgical virtuosity. A study several years ago showed that outcomes in the first two to 4 years after becoming a cardiac surgical consultant were probably not as good as they should be.  In my opinion, this reflects poor training. Many newly qualified surgeons operate on everyone referred to them, thinking that the referring cardiologist has made a judgement that that particular patient is suitable for surgery. The only person who can make that judgement is the surgeon himself. It is said that a good surgeon knows when to operate and a wise surgeon knows when NOT to operate. The latter skill is one that comes with experience and is one which trainees do not possess.
One way this surgeon dependant variation in outcomes could be mitigated is through teamworking where patients are referred to a team consisting of surgeons of different ages, skills and expertise. This sadly is not the British way!

PEOPLE RESEARCH A CAR MORE THAN THEIR CARDIAC SURGEON

Is this video, from Consumer Reports in the USA, a vision of the future for the UK? I suppose it should be - you just cannot argue against it. The Bristol Heart Surgery scandal and the endeavours of Sarah Boseley at the Guardian led to the eventual publication of individual surgeons' results. Today however, 6 years after the first publication of institutional results and the efforts of the then President of the Society of CT surgeons and the current medical director of the NHS, Sir Bruce Keogh, we are no further forward.

IT'S OK TO SCREW UP, NO REALLY !

Why Letting Yourself Make Mistakes Means Making Fewer of Them | Psychology Today In this paper a psychologist explains how if we mentally give ourselves permission to screw up, we are less likely to do so.

WHAT GOES AROUND, COMES AROUND

Surgeons’ Decisions and the Financial and Human Costs of Medical Care

A good piece by an anesthesiologist in the NEJM today. What I found interesting was the fact that there used to be a chapter on surgical judgement

A MEERKAT REVOLUTION

This weekend, it is reported that Dr. Foster, which is an organisation that analyses outcome data, has published report cards for all acute hospitals in the National Health Service in the UK. Although they have published league tables of risk adjusted mortality rates for hospitals in the past, this is the first time they have used the 'report card' format. The outcomes they have chosen are useful but arbitrary. Spokespersons for the hospitals which have not done well have come up with the usual responses that the report cards do not accurately reflect the risk profile of their local populations .
One outcome which Dr. Foster have used and which I think is quite interesting is the death rate after low risk surgical procedures. It reminds me of a study presented at the annual meeting of our society by Samer Nashef who is a cardiac surgeon at Papworth Hospital in Cambridge and one of the founding fathers of the Euroscore system. The study had the amusing acronym FIASCO . Essentially the deaths of patients with a low Euroscore who died after cardiac surgery were analysed. The numbers involved were as expected very small and within the range expected from their Euroscore. Because of the small numbers involved, this was not a quantitative study with p values but a more of a qualitative one with an in depth analysis of the sets of notes of every individual patient who had died. One reason why this study in particular interested me is that I have written previously on M&M meetings and the way they should be conducted. Anyway back to FIASCO. The study revealed , not surprisingly that low risk deaths are frequently associated with organisational failures. The whole point of surveillance and outcome publishing is to root out correctable failings of any individual hospital. Low risk deaths are therefore a fertile ground to explore and compare.
In the mainstream media , the part of the Dr. Foster's report that has been highlighted has been the one on the small number of hospitals that have significantly higher mortality. What is rapidly becoming clear to me is that these reports, how they are presented and the significance of their content are only really understood by outcome aficionados. Patients ( at whom they are supposed to be aimed) probably never read them because the reports are bewilderingly plentiful, not easily accessible, and are mostly indigestable. The media are selective in their reports and either deliberately or through ignorance misinterpret the results. As a libertarian, I would like to see aids for patients to make choices. However despite attempts by a number of governments over the years, the whole choice agenda still seems alien to me (and even more to patients) when it comes to the National Health Service. Can you really have a market with plurality of supply when it's already paid for. If and when patients have to make a choice , we need a Compare the Meerkat or a Go Compare revolution .

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