Evaluating Surgical Outcomes.

Welcome to the wonderful world of " surgery " which most of us will need sometime in our lifetime. The medical profession refers to us as " patients " , but in reality we are " customers " seeking a surgeon with the skill to perform the intricate work within our bodies for which they have trained. There are usually several offering their services and we tend to pick the one we think has the best outcome reputation, or we are guided by the general practitioner who writes an introduction known as a " referral ".

There are seven thousand specialist doctors in Australia who profess to be surgeons and they are scattered across the wide area of medical specialities.  The fees they charge for their services is a matter of negotiation between doctor and patient, but in many cases it exceeds the fee schedule provided by the government health service.  As a consequence, the patient needs to meet those out of pocket expenses.

These medical specialities tend to be well defended fortresses.  The existing members decide how many new entrants will be admitted each year and newcomers are carefully selected to conform to the ethics of the " club ".  A new entrant may charge a little less than a long serving surgeon, but selection is based on guidelines of assuring that price stability is maintained and nobody " rocks the boat " !

Now a leading surgeon has broken ranks and published a five year audit on his website which reveals the number of surgeries he has performed and benchmarked his complication rate against clinical indicators published by the Australian Council of Health Standards.

This is like a breath of fresh air in a musty room.  Surgeons are required to conduct yearly audits of their surgical outcomes and submit them for peer review as a condition of their registration, but in reality this is ignored.  Should pressure ensure that this happens the public would have the ability to  compare the success rate of individual surgeons when making their choice.

Of course,  adverse outcomes are a possibility with any surgical treatment, no matter who is doing it.  That doesn't mean they are a bad surgeon but in that profession reputation is everything and disclosure was avoided because of fear about how the data would be interpreted.

Australia's chief medical officer has called on surgeons to end guarding this data on their outcomes.  The other concern expressed by patients is the difficulty in determining the final cost outcome of various surgical procedures.    A surgeon is entitled to charged a premium based on his or her skill with that particular medical procedure.  Like any other financial transaction, the  buyer is  entitled to know the final cost before proceeding further.

It seems that new ground is being broken.   Hopefully, the mystery behind the hospital door might be about to dissipate.