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Risk warning amid death rates move

Publishing individual surgeons' death rates could lead to doctors turning away "high-risk" cases, according to an article in a leading medical journal.

Giving the public access to surgeon-specific mortality data shifts the emphasis from "patient care to self preservation", according to an editorial published in the British Medical Journal.

Last June, health officials launched the first-ever performance outcomes for medics.

The information - central to Government plans for a more transparent health service - aim to show patients how well consultants working in a number of specialities across England perform against their peers.

Patients can see the number of times a consultant has done a procedure, their mortality rates and whether or not they are performing within the "expected range".

The initiative aims to "shine a light on variation and unacceptable practice", NHS officials said at the time.

But Stephen Westaby, a consultant cardiac surgeon at John Radcliffe Hospital in Oxford, argued that most deaths are related to "team dynamics" and hospital infrastructure rather than surgical error.

"To the public, surgeon-specific mortality data (SSMD) reflect surgeons' technical competence," he wrote.

"Yet in reality team consistency and operating theatre practice supersede individual performance.

"Publication of SSMD diverts attention from deficiencies in NHS infrastructure.

"An understanding of why patients die allows something to be done about it; attributing a pile of bodies to an individual surgeon does not."

Publishing mortality data "has not improved patient choice, waiting lists, equipment, staffing or team consistency," he said.

He also cited publication of surgeon death rates in parts of the US in the 1980s, saying: "Soon afterwards, risk-averse behaviour and gaming with risk stratification were widely documented.

"The answer was to avoid high-risk patients."

He added: "Risk-averse behaviour exists...The drivers are self protection or the prestige and private practice that come with topping the league."


From Belfast Telegraph