In article <cUfwj.47790$9j6.44081@attbi_s22>,
"Skeptic" <bcs002b@yahoo.com> wrote:


BUT... should we all have this data readily available? If you're looking
a
surgery you do 6 times a year, and you live in a small town...
confidentiality becomes a real issue.

I don't see how. You say I had six surgeries last year and of that
1 had this problem, 2 this one, etc. You aren't releasing any
identifiable information in the context of the laws.
You also say that everyone practicing in the hospital (or county or
whatever the appropriate distinction is) did a total of X surgeries last
year and of that Y had this problem, Z had this one, etc.

If you are a tertiary care center and
an oncologic surgeon who ends up doing most the really aggressive
prostate
cancer surgeries, you'll end up with higher + margins, more
complications,
and in general, outcomes that will look worse on paper. Conversely, if
surgeons in community are to be judged on this sort of thing, you know
what?

Yet, don't many of these have well-established severity surveys that
could help sort out of the severity adjusted numbers?

"George Conklin" <nil@earthlink.net> wrote in message
news:13s2ulhtguiv0f0@corp.supernews.com...
Ok, I get it. If we find out a doctor harms patients, then that must
be
hidden to protect privacy. You just got done saying EVERYONE knew. Now
you
say it is unethical to let patients know about bad doctors. Figures.

Context, George, context. What information should be given?

Say prostate cancer surgery (I'm more familiar with this). Information
that
is potentially helpful to patients would include but not be limited to:
positive margin rate, postop urinary continence, transfusion rate, blood
loss, rate of bladder neck contractures, postop erectile function,
survival,
postop lymphoceles, rate of biochemical recurrence, length of hospital
stay,
etc etc.

These are all things I discuss with my patients. I don't hide any of
them.
BUT... should we all have this data readily available? If you're looking
a
surgery you do 6 times a year, and you live in a small town...
confidentiality becomes a real issue. If you are a tertiary care center
and
an oncologic surgeon who ends up doing most the really aggressive prostate
cancer surgeries, you'll end up with higher + margins, more complications,
and in general, outcomes that will look worse on paper. Conversely, if
surgeons in community are to be judged on this sort of thing, you know
what?
You'll see them cherry pick their surgeries. Why operate on a big fat guy
that has potentially for more complications? Why operate on an aggressive
cancer since you run a risk of lowering your average of having + margins?
Send him off to the nearest "University Hospital" for that surgery (with
all
the associated time delays risking metastatic cancer).

I dont' disagree with your basic premise that the patient should have a
way
to judge his doctor. I DO disagree with the blanket manner in which you
would want to implement that. You don't seem to have thought through the
repurcussions of that line of thinking, much like the politicians in
Washington.

"George Conklin" <nil@earthlink.net> wrote in message
news:13s086gouc41lec@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:44Avj.44787$9j6.36928@attbi_s22...

"George Conklin" <nil@earthlink.net> wrote in message
news:13rs71j4tt7qibc@corp.supernews.com...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:9qa195-n3h.ln1@news.lumbercartel.com...
In message <13rrsrii43e7qf5@corp.supernews.com>, George Conklin wrote:
"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

Of course not? Fixing errors is part of the cost of doing business in
all other fields. If the mechanic ruins your car, the dealer's insurance
from the dealer covers that.

he/she
is not responsible but you are. Medicine is still based on the
small-business model of 1900, but there used to be personal responsibility
what went with that model.

If gastroenterologists had to pay out of pocket for the expenses of every
ruptured colon (let's say 1 in 100 or so, but I'm honestly not up to date on
the current perf rate) then they and all other MD's would cease to do
colonoscopies except in medical emergencies.

If I had to pay for all incontinence surgery after a prostatectomy (about
2-5% will have urinary leakage after surgery and require some sort of
procedure to correct that) I would stop doing them tomorrow and never even
consider doing one again.

In medicine there are known adverse events of surgery/procedures. We do our
best to minimize them. I agree we can and should do more. But the
cowboy/ignorant attitude of "well, just have the doctor pay the subsequent
medical costs" is not a solution - it's a childish knee jerk reaction that
has no basis in reality.

"George Conklin" <nil@earthlink.net> wrote in message
news:13s1dn2h2ln8t43@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Pp1wj.47029$yE1.44171@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13s14g5dcu5443d@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:WNVvj.46458$yE1.30432@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13s08bme106h22c@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:y2Avj.45039$yE1.35563@attbi_s21...

"George Conklin" <nil@earthlink.net> wrote in message
news:13rrsrii43e7qf5@corp.supernews.com...

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:Sg6vj.42739$9j6.31268@attbi_s22...

"D. C. Sessions" <dcs@lumbercartel.com> wrote in message
news:jkpt85-1oi.ln1@news.lumbercartel.com...
In message <xMMuj.41516$yE1.27616@attbi_s21>, Skeptic wrote:

Everyone except the patient, who is never allowed to know who the bad
players are.

A patient in for a routine colonoscopy meets the doctor beforehand,
discusses the procedure, etc. If there is ever a perforation or some
other
problem, they know exactly who to come looking for.

But the patient never knows who is the player with a high number of
ruptures. That is carefully hidden from the patient. You wrote "EVERYONE
(hospital administration, coworkers, and the surgeon who comes out in the
middle of the night)" knows...but never the patient. Greshams law applies
here.

And does anyone really keep track of the physician who
perforates colons at the higher rate than expected?

I'll be perfectly honest - yes and no. Since there is not one "correct"
perforation rate and since such events are rare, it would hard to measure
accurately.

You are engaging in mystification here. No one can know? You just got
done saying EVERYONE knows....know you say no one knows.

That's the "no" part. The "yes" part is if there is an obvious
trend ... example 3 of the last 10 ended up colostomies - that would
noticed
by the department head, hospital administrator, and the general surgery
department.

Is that data every
systematically collected? Who would ever know? It is kept secret to
protect the system.

Who do you think should have access to such information?

PATIENTS

So patients should be given information about other patients? Hmm... that
might violate a few laws and ethical codes.

In article <cUfwj.47790$9j6.44081@attbi_s22>,
"Skeptic" <bcs002b@yahoo.com> wrote:

BUT... should we all have this data readily available? If you're looking a
surgery you do 6 times a year, and you live in a small town...
confidentiality becomes a real issue.
I don't see how. You say I had six surgeries last year and of that
1 had this problem, 2 this one, etc. You aren't releasing any
identifiable information in the context of the laws.

You also say that everyone practicing in the hospital (or county or
whatever the appropriate distinction is) did a total of X surgeries last
year and of that Y had this problem, Z had this one, etc.

If you are a tertiary care center and
an oncologic surgeon who ends up doing most the really aggressive prostate
cancer surgeries, you'll end up with higher + margins, more complications,
and in general, outcomes that will look worse on paper. Conversely, if
surgeons in community are to be judged on this sort of thing, you know what?

Yet, don't many of these have well-established severity surveys that
could help sort out of the severity adjusted numbers?

In message <cUfwj.47790$9j6.44081@attbi_s22>, Skeptic wrote:

These are all things I discuss with my patients. I don't hide any of them.
BUT... should we all have this data readily available? If you're looking a
surgery you do 6 times a year, and you live in a small town...
confidentiality becomes a real issue. If you are a tertiary care center and
an oncologic surgeon who ends up doing most the really aggressive prostate
cancer surgeries, you'll end up with higher + margins, more complications,
and in general, outcomes that will look worse on paper. Conversely, if
surgeons in community are to be judged on this sort of thing, you know what?
You'll see them cherry pick their surgeries. Why operate on a big fat guy
that has potentially for more complications? Why operate on an aggressive
cancer since you run a risk of lowering your average of having + margins?
Send him off to the nearest "University Hospital" for that surgery (with all
the associated time delays risking metastatic cancer).

Data collection and reduction, accounting for known influences.
Nothing radical. I can think of any number of candidates for
the role, all of which would be in a position to remove personally
identifiable details and adjust for factors that affect outcomes
such as those you mention. One, just as an example, would be
the State medical boards. Already funded (if not enough to
really do their jobs), already (theoretically) with the charter
to perform "quality assurance" on medical care.

Once set up, it's much less complicated than what's already
going on with claims submittal, since the input data is the
same. The software itself is going to be common across the
USA and probably the world.

"Kurt Ullman" <kurtullman@yahoo.com> wrote in message
news:kurtullman-D77810.10522424022008@70-3-168-216.area5.spcsdns.net...
In article <cUfwj.47790$9j6.44081@attbi_s22>,
"Skeptic" <bcs002b@yahoo.com> wrote:

If you are a tertiary care center and
an oncologic surgeon who ends up doing most the really aggressive
prostate
cancer surgeries, you'll end up with higher + margins, more
complications,
and in general, outcomes that will look worse on paper. Conversely, if
surgeons in community are to be judged on this sort of thing, you know
what?

Yet, don't many of these have well-established severity surveys that
could help sort out of the severity adjusted numbers?

No. There is no such survey. Now, might we be able to create one that
would help? Possibly. But now you'd be relying on the patient reading that
Dr. Smith has more complications but a higher "severity survey" or "degree
of difficulty" and somehow making heads or tails over that. Since that's
hard enough to do for those that are actually doing the surgeries, it is
probably a bit much to ask of John Doe who fixes cars and needs his prostate
operated on.

"Skeptic" <bcs002b@yahoo.com> wrote in message
news:cUfwj.47790$9j6.44081@attbi_s22...

"George Conklin" <nil@earthlink.net> wrote in message
news:13s2ulhtguiv0f0@corp.supernews.com...

I dont' disagree with your basic premise that the patient should have a
way
to judge his doctor. I DO disagree with the blanket manner in which you
would want to implement that. You don't seem to have thought through the
repurcussions of that line of thinking, much like the politicians in
Washington.

Multivariate analysis could take care of all your objections, which are
usually given to avoid any comparisons.