Comment by neuro_imager | Hacker News Reader

Comment by neuro_imager | Hacker News Reader

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Outcomes (including complication rates) are typically recorded based on history, clinical examination and lab and imaging results.

- History and physical exam are extremely subjective.

- Medical notes and records can be massaged to sound better than reality (The patient didn't have a stroke after their operation. They had "minor lower limb weakness which we anticipate will improve over the next few weeks") or attributed to all sorts of things (patient's cognitive function hasn't worsened, they have some "fatigue" following surgery).

- People can be very selective about which studies are ordered.

- Junior and ancillary staff are reluctant to report poor outcomes about established senior people.

I'll give a real-life example: Professor X is a "world-renowned expert" on neurosurgery at an academic mecca. He claims a "1-2%" complication rate on aneurysm surgeries in the clinic and at any conferences. His residents know he performs outdated surgeries with spectacularly bad outcomes but no one would be willing to talk about this openly unless they want to torpedo their career prospects.

Probably going to sound naive, as I'm not at this stage of my training yet, but if not saying anything led to patients dying or suffering, I don't think it's worth whatever career prospects were potentially attainable. It's ethically horrendous to consider that would be my life until I too held a superiority complex.

Never underestimate the power of a mortgage to make smart people bend over backwards to not notice something.

Someone close to me, a very experienced nurse, reported some misconduct on the part of a senior physician. This was both required by law and an ethical duty.

She essentially got blackballed from that hospital as a result.

Just out of curiosity, did she report this to the hospital itself? If I were placed in that situation, it would make more sense to go to a more impartial authority, such as the state medical licensure board.

Actually what would be naive would be to think that you would be able to change the situation by whistleblowing.

And before you judge anyone too harshly, talk to me again when you have 300k of debt and you're a fourth year resident stuck in a singularly focused career pathway.

Also, the reality is most people have so much else going on to concern themselves with that these things are given little thought.

So how would you go about preventing this from happening? The false reporting of outcomes by those in power.

Honestly, the only way I can think of would be for the system to be rebuilt from the ground up with more objective, reliable, verifiable data (and data capturing mechanisms).

Accumulation of power inevitably leads to abuses of said power, at least in my experience.

I'm assuming you are in neurosurgery, a highly competitive field with a large number of consequences in any given procedure. How would this compare with cardiothoracic surgery, where (at least in the US) each physician has to publicly report their mortality rates. I know that CT surgery isn't nearly as competitive as it once was, but if you have any historical insight it would be much appreciated.

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