Introduction: Accountability, informed consent and clinician performance information
Published online by Cambridge University Press: 08 August 2009
Summary
Every few years a rogue doctor comes to prominence in the international media. Some, like James Wisheart, the senior paediatric cardiac surgeon at the centre of the Bristol Royal Infirmary Scandal are deemed to be plainly incompetent to perform the operations that they have been undertaking. Others, like Jayant Patel, the surgeon at the centre of the recent scandal at the Bundaberg Base Hospital in Queensland, Australia, appear from the evidence to combine incompetence to perform operations undertaken with a willingness to place their patients in situations of unnecessary risk. The focus of the media on such sensational cases can obscure the fact that there are many less newsworthy, but nevertheless incompetent, physicians practising. According to Atul Gawande, science and technology writer for the New Yorker:
In medicine, we all come to know such physicians: the illustrious cardiologist who has slowly gone senile and won't retire; the long-respected obstetrician with a drinking habit; the surgeon who has somehow lost his touch.
(2002, p. 89)When people are faced with the prospect of having to undergo surgery, they invariably like to be reassured that they will receive a high standard of care. There are many variables that contribute to the determination of the standards of care in a surgical operation. One of them is surgeons' performance ability. Surgeons vary considerably in their ability to conduct particular operations. Some are outstanding performers, some are adequate performers and some are inadequate.
- Type
- Chapter
- Information
- Informed Consent and Clinician AccountabilityThe Ethics of Report Cards on Surgeon Performance, pp. 1 - 22Publisher: Cambridge University PressPrint publication year: 2007
References
and (2004). Ethics, philosophy and evidence-based medicine. Journal of Medical Ethics, 30, 119.CrossRefGoogle ScholarPubMed
Banks, G., Halstead, R., Humphry, R. and MacRae, A. (2006). Rethinking regulation, Australian Government, Canberra. Available at: http://www.regulationtaskforce.gov.au/finalreport/index.html.
and (2003). Taking stock of volume-outcome studies. Journal of Clinical Oncology, 21, 393–4.CrossRefGoogle ScholarPubMed
, , , , and (2003). Surgeon volume and operative mortality in the United States. New England Journal of Medicine, 349, 2117–27.CrossRefGoogle ScholarPubMed
(1998). Professional misconduct: the Bristol case. Medical Journal of Australia, 169, 369–72.Google ScholarPubMed
, , et al. (2003). Surgeon specific mortality in adult cardiac surgery: comparison between crude and risk stratified data. British Medical Journal, 327, 13–17.CrossRefGoogle ScholarPubMed
(2002). Achieving and sustaining improved quality: Lessons from New York State and cardiac surgery. Health Affairs, 21, 40–51.CrossRefGoogle ScholarPubMed
, and (1996). Benefits and Hazards of Reporting Medical Outcomes Publicly. New England Journal of Medicine, 334, 394–8.CrossRefGoogle ScholarPubMed
, , and (2005). Public reporting of individual surgeon performance. [Letter] Medical Journal of Australia, 183, 543.Google ScholarPubMed
(1934). The Shoulder: Rupture of the Supraspinatus Tendon and other Lesions in or about the Subacromial Bursa. Boston: Todd.Google Scholar
, , , and (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington: Institute of Medicine, National Academy of Sciences.Google Scholar
Davies, G. (2005). Queensland public hospitals Commission of Inquiry – report, Brisbane: Queensland State Government. Also at: www.qphci.qld.gov.au.
(1995). Performance reports on quality – prototypes, problems and prospects. New England Journal of Medicine, 333, 57–61.CrossRefGoogle ScholarPubMed
and (1986). A History and Theory of Informed Consent. New York: Oxford University Press.Google Scholar
Forster, P. (2005). Queensland health systems review – final report, Brisbane, Queensland State Government. Also at: http://www.health.qld.gov.au/health_sys_review/final/default.asp.
(2002). Complications: A Surgeon's Notes on an Imperfect Science. London: Profile Books.Google Scholar
Glastris, P. (2005). Pay for Performance Medicine, Washington Monthly, March 13: http://www.washingtonmonthly.com/archives/individual/2005_03/005834.php.
(2002). Ethics and Evidence-Based Medicine: Fallibility and Responsibility in Clinical Science. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
, , and (2003). Provider profiling and quality improvement efforts in coronary artery bypass graft surgery: the effect on short-term mortality among Medicare beneficiaries. Medical Care, 41, 1164–72.CrossRefGoogle ScholarPubMed
Healthcare Commission (2006). Press Release, ‘Patients now have access to rates of survival for health surgery for the first time’, available at: www.healthcarecommission.org.uk (published 27 April 2006).
, and (2005). Hospital performance reports: impact on quality, market share and reputation. Health Affairs, 24, 1150–60.CrossRefGoogle ScholarPubMed
, , , and (2003). Role of surgeon volume in radical prostatectomy outcomes. Journal of Clinical Oncology, 21, 401–5.CrossRefGoogle ScholarPubMed
and (2005). Surgeon-specific report cards. Australian and New Zealand Journal of Surgery, 75, 927–8.CrossRefGoogle ScholarPubMed
and (2006). Sea change: public reporting and the safety and quality of the Australian health care system. Medical Journal of Australia, 184, S44–7.Google ScholarPubMed
Joint Commission on Accreditation of Health Care Organizations (2006). Ernest Amory Codman Award: http://www.jointcommission.org/Codman/.
and (1998). Ernest Avery Codman, 1869–1940: a pioneer of evidence-based medicine: the end result idea. Spine, 23, 629–33.CrossRefGoogle Scholar
, , , , and (2004). The legacy of Bristol: Public disclosure of individual surgeons' results. British Medical Journal, 329, 450–4.CrossRefGoogle ScholarPubMed
, and (2000). To Err is Human: Building a Safer Health System. Washington: Institute of Medicine, National Academy Press.Google Scholar
Konkes, C. (2005). Rating plan for doctors a bitter pill. The Hobart Mercury, April 13.
and (2005). Five years after To err is human: What have we learned? Journal of the American Medical Association, 293, 2384–90.CrossRefGoogle Scholar
, and (2005). Public disclosure of surgeon specific report cards – current status of the debate. Australian and New Zealand Journal of Surgery, 75, 1000–4.CrossRefGoogle ScholarPubMed
, , and (2000). Dying to Know: Public Release of Information about Quality of Health Care. Santa Monica CA: RAND Corporation/Nuffield Trust, 2000. Available at: www.rand.org/publications/MR/MR1255/.Google Scholar
and (2002). Public reporting of comparative information about quality of healthcare. Medical Journal of Australia, 176, 205–6.Google ScholarPubMed
, , and (2003). Public reporting on quality in the United States and the United Kingdom. Health Affairs, 23, 134–48.CrossRefGoogle Scholar
, , and (2001). Bristol, Shipman, and clinical governance: Shewhart's forgotten lessons. The Lancet, 357, 463–7.CrossRefGoogle ScholarPubMed
Morris, K. and Zelmer, J. (2005). Public Reporting of Performance Measures in Health Care, Canadian Policy Research Networks, Health Care Accountability Papers no. 14, Ottawa: http://www.cprn.com/documents/34864_en.pdf.
and (eds.) (1999). Cardiovascular Health and Services in Ontario: An ICES Atlas. Toronto: Institute for Clinical Evaluative Sciences.Google Scholar
, and (2004). Public reporting of individual surgeon performance information: United Kingdom developments and Australian issues. Medical Journal of Australia, 181, 266–8.Google ScholarPubMed
New York State Department of Health (2005a). Adult Cardiac Surgery in New York State 2001–2003: http://www.health.state.ny.us/nysdoh/heart/pdf/2001-2003_cabg.pdf.
New York State Department of Health (2005b). Percutaneous Coronary Interventions (Angioplasty) in New York State, 2001–2003: http://www.health.state.ny.us/nysdoh/heart/pdf/pci_2001-2003.pdf.
(2003). The Doctor's Plague: Germs, Childbed fever and the Strange Story of Ignac Semmelweis. New York: Norton.Google Scholar
, , , and (1998). The effects of New York's bypass surgery provider profiling on access to care and patient outcomes in the elderly. Journal of the American College of Cardiology, 32, 993–9.CrossRefGoogle ScholarPubMed
Reid, C. M., Davern, P., Birrell, S., Billah, B., Skillington, P. and Shardey, G. (2005). Cardiac surgery in Victorian public hospitals 2003–04: report to the public: http://www.health.vic.gov.au/specialtysurgery/downloads/cardiac-surgery-report04.pdf.
and (2000). Margin of Error: The Ethics of Mistakes in the Practice of Medicine. Hagerstown: University Publishing Group.Google Scholar
and (2001). Publicly disclosed information about the quality of health care: response of the US public. Quality Health Care, 10, 96–103.CrossRefGoogle ScholarPubMed
and (2006). Public reporting of hospital outcomes based on administrative data: risks and opportunities. Medical Journal of Australia, 184, 571–5.Google ScholarPubMed
, , , , and (2005). The Western Australian audit of surgical mortality: advancing surgical accountability. Medical Journal of Australia, 183, 504–8.Google ScholarPubMed
and (1998). Medical Harm: Historical, Conceptual, and Ethical Dimensions of Iatrogenic Illness. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
(2005). Performance measurement in health care: history, challenges and prospects. Public Money and Management, 25, 213–20.CrossRefGoogle Scholar
(1998). All changed, changed utterly. British medicine will be transformed by the Bristol case. British Medical Journal, 316, 1917–18.CrossRefGoogle Scholar
(1999). Surgical audit: statistical lessons from Nightingale and Codman. Journal of the Royal Statistical Society, Series A, 162, Part 1, 45–58.CrossRefGoogle Scholar
, and (2005). Surgical accountability: a framework for trust and change. Medical Journal of Australia, 183, 500.Google Scholar
and (2003). Impact of an acute myocardial infarction report card in Ontario, Canada. International Journal for Quality in Health Care, 15, 131–7.CrossRefGoogle ScholarPubMed
, , and (eds.) (2006). Access to Health Services in Ontario: ICES Atlas, 2nd edn., Toronto: Institute for Clinical Evaluative Sciences. http://www.ices.on.ca/file/ICESAccess_atlas_2nd_ed_Prelim.pdf.Google Scholar
(1998). Informed Consent: Patient Autonomy and Clinician Beneficence within Health Care. Second edition, Washington: Georgetown University Press.Google Scholar