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BMJ 2002;324:615 ( 9 March )

Letters

Death rates of surgeons should not be published

EDITORSurgical organisations seem generally to have accepted the proposal to publish the death rates of individual surgeons. As a physician of sorts, although soon to be deregistered, I stand amazed. Although surgeons have rightly questioned the validity of rates that depend predominately on the nature of the problem and on the previous health of the patient, rather than on individual surgical skill, that is not the main objection to the proposal. Consider its possible effects. Unless surgeons are to be cloned, a range of competence will be found in any group of surgeons, which may, or may not, be reflected in death rates, because of the confounding factors.

But even if the rates were a valid indicator of competence, what would result from their publication? Either nothing (which would be sensible), or a trend by referring doctors or choosing patients to pick the surgeons at the upper end of the list. If this second reaction were widespread, it would produce one group of surgeons who were overstretched, and also tempted to opt for "safer" patients and procedures in order to preserve their safety status, and another group of surgeons who were underemployed, and increasingly out of practice. The raw consumerist reaction to that (often exemplified in the press) might be, "Well, sack them."

A gloomy picture, but I hope an unlikely one. From extensive experience, I have faith in the good sense of doctors and patients to discern that this proposal is a spin reaction to consumerism gone mad. I am optimistic enough to hope that the information generated by what will be a costly exercise will be largely ignored. But the best option is not to do it.

Douglas Black, forner chief scientist, Department of Health and Social Security. 
Ironbridge, Telford TF8 7DW

© BMJ 2002
 

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Death rates of surgeons and psychiatrists

Detlef Degner, et al.

bmj.com, 10 Mar 2002 [Response]

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