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The decision of Scotland’s information commissioner to order release
of information on death rate data (1) is bad news for patients as it will
make it harder for poor risk patients to find treatment.
There are many factors involved in hospital mortality. If the
surgeon’s name is to be released after any death, so should the
anaesthetist’s since anaesthetic error can cause deaths. The quality of
nursing also affects the postoperative course, and so we also need to know
the ward sister’s name, and similarly the names of the physiotherapists.
The hard work and dedication of health care professionals can be
undermined by the poor running of units, understaffing etc, and so we need
the names of the managers involved. Many MPs take a close interest in
their local hospitals, fighting for resources and good management, and so
any hospital death to some extent reflects failure on their part, and we
therefore need the MP’s name and political affiliation.
But the biggest factor in hospital mortality is probably lifestyle
choices made by the patients themselves, since smoking, fitness levels and
obesity are all known to affect outcome. Since many patients obtain their
information on lifestyle choices from their newspaper, we clearly also
need to know the patient’s newspaper after any death. Then newspapers can
be ranked in terms of how informative their health and lifestyle reports
have been.
The Scottish health service is right to refuse to release information
about the surgeon’s name if this is the only information it has. It would
be equally wrong to release the name of just the anaesthetist, and so on.
To single out one group for reporting is to imply that all deaths are due
to the incompetence of that group, and that the surgeon associated with
the worst rate is the worst surgeon. Surely, in the absence of other
evidence of a surgeon’s incompetence, this would be grossly unfair and
possibly libellous. In my view, very few of the deaths in hospital are
due to an error by a surgeon, and so surgeons cannot be judged by the
mortality rates of their patients. But this is only an opinion. If we
are to use ranking tables, we need research on how much of the variability
in outcome is due to each of the many factors, i.e. before we use ranking
tables, or release information that can be used to construct them, we need
to make them evidence-based.
One further point is that the news article was titled ‘Scottish
health service is ordered to release data on surgeons’ performance’. The
word performance in the title should be put in inverted commas, as we do
not actually have data on their performance, only on the mortality of
their patients, and we do not know in what way it reflects their
performance. Of course, it may be that the best surgeon is referred the
most difficult cases, and so his patients have the worst outcome despite
his expertise.
1 Christie B. Scottish health service is ordered to release data on
surgeons’ performance. BMJ 2005;331:1424 (17 December)
Surgeons’ ‘performance’
The decision of Scotland’s information commissioner to order release
of information on death rate data (1) is bad news for patients as it will
make it harder for poor risk patients to find treatment.
There are many factors involved in hospital mortality. If the
surgeon’s name is to be released after any death, so should the
anaesthetist’s since anaesthetic error can cause deaths. The quality of
nursing also affects the postoperative course, and so we also need to know
the ward sister’s name, and similarly the names of the physiotherapists.
The hard work and dedication of health care professionals can be
undermined by the poor running of units, understaffing etc, and so we need
the names of the managers involved. Many MPs take a close interest in
their local hospitals, fighting for resources and good management, and so
any hospital death to some extent reflects failure on their part, and we
therefore need the MP’s name and political affiliation.
But the biggest factor in hospital mortality is probably lifestyle
choices made by the patients themselves, since smoking, fitness levels and
obesity are all known to affect outcome. Since many patients obtain their
information on lifestyle choices from their newspaper, we clearly also
need to know the patient’s newspaper after any death. Then newspapers can
be ranked in terms of how informative their health and lifestyle reports
have been.
The Scottish health service is right to refuse to release information
about the surgeon’s name if this is the only information it has. It would
be equally wrong to release the name of just the anaesthetist, and so on.
To single out one group for reporting is to imply that all deaths are due
to the incompetence of that group, and that the surgeon associated with
the worst rate is the worst surgeon. Surely, in the absence of other
evidence of a surgeon’s incompetence, this would be grossly unfair and
possibly libellous. In my view, very few of the deaths in hospital are
due to an error by a surgeon, and so surgeons cannot be judged by the
mortality rates of their patients. But this is only an opinion. If we
are to use ranking tables, we need research on how much of the variability
in outcome is due to each of the many factors, i.e. before we use ranking
tables, or release information that can be used to construct them, we need
to make them evidence-based.
One further point is that the news article was titled ‘Scottish
health service is ordered to release data on surgeons’ performance’. The
word performance in the title should be put in inverted commas, as we do
not actually have data on their performance, only on the mortality of
their patients, and we do not know in what way it reflects their
performance. Of course, it may be that the best surgeon is referred the
most difficult cases, and so his patients have the worst outcome despite
his expertise.
1 Christie B. Scottish health service is ordered to release data on
surgeons’ performance. BMJ 2005;331:1424 (17 December)
Competing interests:
None declared
Competing interests: No competing interests