Its happening and its happening fast. What the cardiothoracic surgeons in the UK have lived with for 8 years is coming to a specialty near you very soon. Individual urological surgeons results to be published openly, in the press in the UK from summer 2013.
It’s a massive change to the way we work and to the way surgical data is presented. No longer will the interesting elements of the urological literature be studies of the results of a few surgeons in a few centres of world renown but rather the performance of outliers. Reports will start to reflect what is achieved throughout the nation not in one or two centres in that nation. Warts and all if you like.
There are risks. Big risks. For surgeons and for patients.
Will surgeons who operate on high risk cases be smeared because they appear to be underperforming?
Will patients who are high risk be denied operations because surgeons subliminally start to make recommendations that are good for the surgeon but not for the patient?
Will surgeons continue to train junior surgeons or will juniors simply cut the stitches?
Why should surgeons carry the can for the performance of the whole team?
Will sample sizes be big enough to ensure that results could not be due to chance?
What outcomes should we be measuring in order to judge the quality of many operations?
Who should collect the data – the surgeons or independent reviewers?
Are surgeons going to be tabloid fodder?
Is it simply time to head for the hills with a cigar and a bottle of red…..
In cardiac surgery all these were live questions and they have worked it out. Standards have been shown to be astonishingly high. Will urology be the same? The specialities have been challenged to come up with a plan. Why not contribute to that process and add to the blog….
Tim O’Brien is a Consultant Urological Surgeon at Guy’s and St Thomas’s NHS Hospital, London. His views are his own.
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