5 ms·

Full transparency could have negative unintended consequences. For example, if surgeons knew their success rate were public, they would be incentivized to take

Full transparency could have negative unintended consequences. For example, if surgeons knew their success rate were public, they would be incentivized to take easier cases. Who would take a difficult case if they knew it would constitute a bad mark on their record almost for sure? Fundamentally, the issue is that it's impossible to observe for any given patient if that patient's outcome would have been better with a different surgeon. This is the same challenge we face with evaluating drugs: many more people who take aspirin survive than those who take anti-cancer drugs, but this likely reflects the kind of person who is taking each (people with headaches vs. people who have been diagnosed with cancer). To solve the problem there's no way around randomized trials. So, one idea would be to randomly assign patients to surgeons. (Transparency might still be better on net, but important to keep these issues in mind.)

conorh 11y ago
In places where they have implemented outcome tracking they give patients risk scores and adjust based on those scores - which in itself is tough (bias to give patients worse scores), but you have to start somewhere. I've had this discussion a few times and fundamentally I believe that transparency is better than the zero objective information we have now - currently we don't even know how many operations a surgeon does - let alone the outcomes!
nchammas 11y ago
> For example, if surgeons knew their success rate were public, they would be incentivized to take easier cases. Who would take a difficult case if they knew it would constitute a bad mark on their record almost for sure? Why would it be a "bad mark" if everyone understood the case was difficult? Given a difficult case, wouldn't a surgeon be graded badly only if they did poorer on average than other surgeons tackling similar cases? As long as a case's "difficulty" is measured in a consistent way, I don't see how surgeons would be incentivized to avoid difficult cases.
- riahi 11y ago
  How do you measure difficulty? It's a surprisingly hard problem.
  - nchammas 11y ago
    Good question. Perhaps that is one of the root issues here. As a layperson, I wouldn't know how to answer it, but I'm guessing the answer probably involves more rigorously detailing the various aspects of each case so that comparisons can be fairly made across surgeons treating similar cases--apples to apples and all that.

conorh 11y ago

In places where they have implemented outcome tracking they give patients risk scores and adjust based on those scores - which in itself is tough (bias to give patients worse scores), but you have to start somewhere. I've had this discussion a few times and fundamentally I believe that transparency is better than the zero objective information we have now - currently we don't even know how many operations a surgeon does - let alone the outcomes!

nchammas 11y ago

> For example, if surgeons knew their success rate were public, they would be incentivized to take easier cases. Who would take a difficult case if they knew it would constitute a bad mark on their record almost for sure? Why would it be a "bad mark" if everyone understood the case was difficult? Given a difficult case, wouldn't a surgeon be graded badly only if they did poorer on average than other surgeons tackling similar cases? As long as a case's "difficulty" is measured in a consistent way, I don't see how surgeons would be incentivized to avoid difficult cases.

riahi 11y ago
How do you measure difficulty? It's a surprisingly hard problem.
- nchammas 11y ago
  Good question. Perhaps that is one of the root issues here. As a layperson, I wouldn't know how to answer it, but I'm guessing the answer probably involves more rigorously detailing the various aspects of each case so that comparisons can be fairly made across surgeons treating similar cases--apples to apples and all that.