That's why I said you're what people say you are. Heck, I don't know my own statistics and I don't know where I stand in comparison to my colleagues. Yet I enjoy a very good reputation with colleagues, but patients often are weary of me because I'm socially awkward.
Weary means tired.
Physicians sometimes jokingly refer to surgeons as "technicians" because what they are doing is often more discretely defined, clearer boundary conditions, clearer indicators of performance/success/quality (especially over X number of cases when you know the national averages for outcomes), and ultimately of a mechanical nature. The work physicians do can sometimes be described similarly, but much less frequently and it can be much harder to do.
The physician/surgeon distinction is a critical one in medicine that is under-appreciated in most conversations about "doctors".
I'll let you make some quick inferences using this video https://www.nejm.org/do/10.1056/NEJMdo004274/full/?requestTy... from this paper https://www.nejm.org/doi/full/10.1056/NEJMsa1300625
Crucially, if you can get someone to hide which surgeon is skillful and which one is not and view the video and judge for yourself, you might be surprised at your skill in differentiation. In my experience, my friends have 100% guessed which surgeon is better correctly. So it is possible that this is Sorites-style.
I know a surgeon with a substantial rate of spectacular failure and a very bad reputation. But most of the time, outcomes are excellent. Is that a bad surgeon on average? No idea. And Im in the OR every day.
I assume the general silent belief would be that your guy with the spectacular failure is some kind of "take the tough cases" dude?
By the way, when I was much younger (maybe 10-15 years ago), I recall my dad coming back from an AO Foundation conference where there was a talk about some particular procedure in some Scandinavian country where the range of outcome quality was so high for a particular non-emergency THR/TKR or something like that and so they shut down the procedure in the remote hospitals and centralized it in a few (3?) tertiary healthcare centres. Do you recall something like that? I have this memory in my head but I can't find the original material. The story is so good: EBM driving patient outcomes; but I can't find it so I don't share it and I would like very much to, if it is true.
No, the silent belief is that he's the worst surgeon we have.
> they shut down the procedure in the remote hospitals and centralized it in a few (3?) tertiary healthcare centres. Do you recall something like that?
That's become an extremely common strategy for specialized surgery throughout Europe.
Haha, classic! I love it! I was honestly a little worried of offending you if he was a friend.
> That's become an extremely common strategy for specialized surgery throughout Europe.
There we go. Fine, I'll just go look it up.
There's data flowing all over the place. But perhaps the lawyers and the insurance stand in the way of improvement?
The human body is complex. Why not look for as much help as possible?
That's not a good enough reason.
Given the social and financial magnitude the excuse is nearly criminal.
But.
If they can identify the importance of hand sanitation and implement programs to ensure that, then there is hope. But as it is, it feels like the land of "that's how we've always done things."
Note: this isn't only hospitals but extended care facilities. They're printing money on the backs of the suffering and losses of others.
Do no harm?? Perhaps it once meant something. No much anymore.
We can do somewhat better at measuring quality for larger provider organizations across patient populations. The NCQA HEDIS measures are evidence based and reflect current consensus on best practices.
Suggesting what is available be tracked isn't ignorance, it's innovation and improvement 101. It's a call to prevent waste and unlock societal value. To suggest otherwise is lazy and insanity.
Or perhaps the industry is afraid of something? Fear makes for great excuses.
GP: This condition X is much worse than normal, so I'm going to refer you to Dr. A, the best I know in the field.
Aggregate enough of this and Dr. A has worse outcomes on paper for condition X than everybody else, since s/he gets the patients with the hardest to treat coming in.