And I am completely sympathetic to the argument that this has such fundamental implications from the perspective of patients in Michigan, and why is it that we aren't telling them. I get that.
But at the same time, these Michigan surgeons really took a significant risk, subjecting themselves to this type of study. They deserve credit for doing a very difficult thing, putting the state of science forward. I couldn't in good conscience feel these surgeons should be penalized for the inevitable findings that put surgeons at both ends of this range.
HLM: But if this were to become mainstream, and you had this knowledge, wouldn't you have to tell patients prospectively?
JB: Do you think so? We don't currently. Patients don't have access to other measures of surgeon performance, even when surgeons are systematically tracked and get feedback on their outcomes against their peers. The profession has not made it standard of care for those data to be made available to patients.
I appreciate the distinction… that technical skill has a much more powerful association with a patient's true risk, but at the same time, it falls along a continuum of a broader range of information we have about the knowledge and skills of a physician.
HLM: Not to belabor the point, but in California and some other states, the public has access to mortality rates of named surgeons performing coronary artery bypass procedures. I personally know of physicians whose poor rates prompted their medical executive committees to reroute them to pursue another field of medicine.
JB: Cardiac surgery is the only specialty where that happens, and the public health effect of making that information available has been fairly small. Sometimes, by chance, surgeons can wind up in a given year on the wrong side of the line.
The political challenges are real as well, because surgeons are very sensitive about their outcome rates, and at the end of the day, attribute those to factors bigger than just them. There was real palpable apprehension among the participating surgeons. They appreciated just how threatening this was.