Thursday, June 12, 2008
Too much knowledge is a dangerous thing
Reading the paper over coffee this morning I noticed that Health Ministers are giving the go ahead for hospital consultantsâ€™ success and failure rates to be put on-line. This could be as bad as it gets for patients.
Some time ago now I developed one of the first appraisal systems for top medical professionals. An issue emerged that caused me a great deal of anxiety. Imagine five heart surgeons in a specialty. We want to appraise and measure their expertise so that, if they need extra training we can pinpoint where. We take the hard data on each of them. It turns out that Mrs Brown is by far the worst performer. Roughly 80% of her patients die. Looking into this more deeply we then discover that Mrs Brown ONLY operates on patients with a 2% chance of survival. In other words she is a brilliant surgeon. If we publish her results, she might (as actually happened later in reaction to league tables in some hospitals) decide she is only going to operate on patients who have a reasonable chance of survival. Patients with severe conditions will be turned away. This will make the overall tables for the speciality look a lot better â€“ and the hospital benefits from extra funding!
This is an example of the gruesome consequences of the unforeseen. Often, policies are produced and implemented in social organisations right up to cabinet level, which result in unpredictable side-effects. So, in the case of the publication of consultantsâ€™ surgical records, what might result, adversely? Well, those surgeons who are easily bullied or are vulnerable to criticism, may leave for warmer climes where this tyranny by transparency does not occur. Those that are, like Mrs Brown, capable of offering the 2% chance of survival might withdraw on the basis that all the despairing Googling patients from a thousand square miles might want them to take on their inoperable conditions. Then again, given the way unscrupulous or frightened senior managers have fudged or skewed their hospital data over the last few years, to appear less conspicuously inept in league tables, who is to say that patients will actually be seeing robust evidence of performance, anyway?
BUT, probably the worst fall-out of the proposed online information, is that our terrified, death-sentenced, Googling patients will discover that there is only one Mrs Brown in the country and she just isnâ€™t available, either because of the length of her lists or because sheâ€™s having a break down, trying to manage so many would-be patients. So they have to accept they will be under the knife of Mr Grey, whose success rate with those with a 2% survival-chance is, well, bang-on 2%.
Try telling them to go into the theatre, feeling optimistic .