Comments on: Is publishing ‘league tables’ of surgeons’ performance good for patients?

By: Robert Park

Robert Park — Fri, 14 Jun 2013 11:54:58 +0000

Let us forget about Shipman for the moment. About 40 years ago I had an aunt 74 who was seriously ill with influenza and her sister who lived with her called out the family doctor (a normal practice then). Upon arrival he apparently gave her an injection and departed. The sister then entered the room to find this aunt dead but no enquiry as to why. Consider too, why there are no waiting lists for hospices. There are too many questions going unanswered. Is Shipman’s case then an isolated one?

I subscribe to your other views.

By: Carole_W

Carole_W — Fri, 14 Jun 2013 06:38:49 +0000

Shipman was not incompetent, has was a psychopath, and if league tables has been in place, he would have found some other outlet for his horrific compulsion. You cannot legislate for isolated bizarre experiences without causing significant repercussions for the vast majority. This is put extremely well by Tim Cantopher (a psychiatrist whose main client base these days are public servants – and a bureaucratic blame culture fostered by politicians is the cause:

“What these professions now have in common is that they are all victims of the craze so loved by recent governments for regulation and its attendant bureaucracy. Politicians need to be needed and for us to believe that they can stop things going wrong. They can’t, of course, but they have to be seen to be doing something, or their opposite number will call them complacent.

One person gets one thing wrong with terrible consequences. Here’s how it goes. First, set up an inquiry; second, find and punish a scapegoat; third, introduce a whole ream of bureaucratic structures and paperwork to increase the profession’s/industry’s regulation; and lastly, set up auditing systems to monitor the regulation you have set up. Oops, I’ve destroyed the service in the meantime – never mind; at least I’ve made sure nothing can go wrong again and we all feel better because those originally to blame have been punished.

It’s a high price for society to pay for our politicians’ naivety and arrogance, though. Instead of one catastrophe, we now have an environment that stops people from doing their jobs, leading to a downward spiral of mediocrity and disillusionment.”

As a medic, subject to endless costly, ineffective and soul-sapping hoop-jumping, I couldn’t agree more.

By: Robert Park

Robert Park — Sat, 08 Jun 2013 18:38:28 +0000

Regrettably, I cannot now recall what the name was of the medication but for five years I was in a serious state of health; I felt constantly tired and slept most of the day which did not disturb my nocturnal sleep, indeed, I felt so awful that I thought I would not make it through each day. The GP said the medication would strengthen my heart beat. My feeling of self-confidence dispersed, I became afraid of heights, had what is best described as electrical discharges or short-circuiting in my brain accompanied by mini-blackouts. My energy levels plummeted. After five years I decided to read the literature about the medication and was appalled by the numerous adverse side-effects catalogued. This lead me to read extensively about pharmacy when I discovered selegiline at 5 mg solved the neurological symptoms and CO-Q10 at 100 mg daily restored my energy levels. Later I was to discover that there were other substances which cleared plaque from arteries which would have prevented surgery and which was known to the medical profession yet I was not informed. It is only in the past few weeks that I have been able to ween myself off the selegiline but, of course, I am being careful about it. It will be appreciated that I had to battle with GPs to convince them to prescribe selegiline. Originally I purchased it from other pharmacies outside the UK which was prior to the days of the Internet. It has been a battle and a constant one but the war is has not been won, at least, not yet.

By: Jilly

Jilly — Sat, 08 Jun 2013 13:13:00 +0000

Robert Park, do you mind telling us what was the medication prescribed by your GP and why do you think it was harming you.

By: Sandy

Sandy — Fri, 07 Jun 2013 23:06:20 +0000

As a retired surgeon, I also agree that mortality league tables are almost impossible to interpret without having a lot more information on case mix and factors related to postoperative care. The recent data on mortality related to which day of the week surgery is performed highlights this dilemma.
That having been said audit is vital. Surgical complication rates give a much more accurate indication of a surgeon’s performance. Proper use relies on the recognition by individuals or their peers, that a particular surgeon should not be undertaking certain procedures. Would that it were so easy with so many egos involved!
Interestingly, private medical insurance companies have used length of hospital stay as a surrogate for complications to determine which surgeons would be authorised to perform procedures under their policies. Unfortunately the same non-reimbursable surgeons can carry on doing the procedure in the NHS.

By: Robert Park

Robert Park — Fri, 07 Jun 2013 10:54:38 +0000

Twenty three years ago I had a quadruple by-pass which the surgeon estimated as being possibly about 80% successful. The average life expectancy for cardiac by-passes at the time was 5 years. Around 7 years ago I came across a site on the Internet providing the so called ‘success rate’ of cardiac surgeons at the hospital where I had the operation and the surgeon who performed it was at the bottom of the list! Subsequently, I was seriously ill for the following 5 years only to discover that the medication being administered by my GP was what was almost killing me yet there are no success rates kept on family GPs which is presumably why Dr Harold Shipman (UK) was able to eliminate more than 450 of his patients. On discovering the cause of my ill-health I ceased taking the prescription medication and now in my 80s I feel top of the form. Interestingly the GP never enquired why I ceased taking the medication.

By: Chris

Chris — Fri, 07 Jun 2013 08:29:38 +0000

Trawling similar depths prompted by Robin ..

.. who outside of management and recruitment consultants, who use them to cloak themselves in gravitas, think psychometric tests can describe a persons traits objectively?

Our thoughts and behaviours result from a complex blend of influences that, according to the contemporary thrust in psychology, we rarely notice nor understand, so we wind up with a head full of false narratives and/or preference sensitive beliefs that bear upon our actions. [‘You Are Not So Smart’; David McRaney is worth a read on this].

If management consultants, recruitment consultants, estate agents, and the designers of psychometric tests are ever proven to be exempt from harbouring false narratives along with preference sensitive beliefs and behaviour I’d like an assisted passage through the door marked ‘EXIT’, please.

By: TJ

TJ — Wed, 05 Jun 2013 17:41:18 +0000

As retired orthopaedic surgeon, I agree completely with the article, and amazingly with the points made by the writers above. How does one compare the drunk druggie at three in the morning with a smashed hip after a motorcycle wreck and a clean hip fracture after a fall at home? They are classified exactly the same.
These kind of metrics only work for one type of person: the bureaucratic paper pusher!

By: Robin Dowswell

Robin Dowswell — Wed, 05 Jun 2013 12:28:11 +0000

Very good points made by all above.
Before I became self-employed my previous employer, a big bank, introduced a 64 point appraisal system. An 8*8 matrix of effort vs output (or something like that – I really didn’t care about the details at the time).
As Chris pointed out there are too many jobs involving using metrics. Measurement is an art to be used very carefully. It is the basis for much scientific progress, but misapplied it is a total waste of everyone’s time.

By: David

David — Wed, 05 Jun 2013 11:17:45 +0000

There were suggestions that the Leeds unit at the heart of recent controversy were risk averse.

By: Stephen Rhodes

Stephen Rhodes — Tue, 04 Jun 2013 19:52:26 +0000

This yet another example of the ineptitude of our lords and masters in Westminster. As H.L. Mencken is supposed to have said “For every complex problem there is an answer that is clear, simple, and wrong.” and then Einstein “Everything Should Be Made as Simple as Possible, But Not Simpler”.
It is simply not possible to encapsulate in league tables anything multifactoral especially where people rather than inanimate objects are involved. Schools’ performance is a classic and this is yet another complete waste of time and money. It would be possible to convey the competence of surgeons or schools but HMG have no intention of investing the intellectual effort or taxpayer monies in the process – and since we continue to elect them you might consider that most of us wouldn’t have the ability to properly evaluate the conclusions anyway!

By: Chris

Chris — Tue, 04 Jun 2013 17:28:30 +0000

If it is any consolation to your mates colleague I think a great many people are trending from being previously happy in their work to loathing it.

A lot of this has to be down to being increasingly judged by a narrow band of metrics which completely fail to do justice to the complexities and variables pertaining to performance and outcome. There is nothing like the introduction of a statistic or two to debase the good sense that could well have prevailed before.

In the clamour to make better use of resources I never cease to be amazed by how much time and effort can go into ‘proving’ that somebody who does a difficult job under difficult circumstances could do that job better, in less time, with fewer resources, and a truncated budget. We need more people ‘doing’ and fewer people ‘judging’. Life would be so much happier an event.