4 ms·

The subjective is always where there is value. I wish there were surgeons that would accept these challenges and colleagues would objectively assign a degree o

by aantix 9y ago

The subjective is always where there is value. I wish there were surgeons that would accept these challenges and colleagues would objectively assign a degree of difficulty score. And a site that aggregated such scores. I really don’t care how “friendly” a doctor is - did the get the diagnosis right? Did they improve longevity? Did they improve quality of life? Not easy to score but what everyone wants to know.

slap_shot 9y ago
Not sure why this is being downvoted. It’s a legitimate request. I worked for a novel medical device company and we had a lot of surgeons on staff. While not a product we’d ever build, there was always discussion amongst the doctors of how to better grade physicians and specifically surgeons. The concern is was that a lot, and I mean a LOT, of surgeons were bad at their job. They were always proposing different systems to evaluate surgeons, very close to what you described.
- ItsMe000001 9y ago
  > ... and colleagues would objectively assign a degree of difficulty score. He asks for a level of "objectivity" that you just can't get. What do you think medicine is? Like repairing toasters? "Why don't you simply assign some objective numbers" - it's so easy! No it is not, unless you only count a set of basic and routine procedures. Even things like a broken bone vary greatly - and then add the additional variance of the people having those broken bones. You can sort of get some objectivity when you do statistics of lots and lots of patients in many places over long periods - but the problem OP wants is to be able to make statements about individuals (doctors). Being able to say something about a population is very different from saying something about an individual within the population. "Statistics" about a single doctor are and will be full of randomness. Besides, if they did what I quoted from OPs statement above what would probably happen is that everybody declares everything as "very difficult" (or just below) expecting colleagues to do the same for them. In Germany private insurance has a multiplier on the amounts they can charge for something. Guess what: Everything is now declared as "very difficult" (with some short fuzzy explanation), multiplier 2.3. Almost nothing is charged at the "normal difficulty" rate. > Did they improve longevity? Did they improve quality of life? Given that each doctor is highly specialized, and that on the other hand your GP, the one who treats you long-term, can't actually do much when there is anything serious, those numbers are mostly out of the control of individual doctors. You would have to get such numbers system-wide, not per doctor. Medicine is supplied to patients throughout their life (incl. late life) by a network, not by an individual. There also is a huge impact of ones own life choices (e.g. obesity, smoking), and no, you can't just correct for them - not individually (for populations we can). All those numbers would look terrible for doctors who treat more of the worse cases. It would lead exactly to what the article is about. I'm not arguing against trying to measure surgeon outcomes - I'm against trying to use those measures for things they are not good for.
  - aantix 9y ago
    The feedback would have to be anonymous. It’s the only way to get honest scoring.
carbocation 9y ago
What you're describing is commonly referred to as "propensity weighting." It is a good first step, though most of us think it still doesn't do a sufficient job of accounting for the risk of difficult cases.
sky_rw 9y ago
Does the NHS provide enough free market choice that anybody could take advantage of a score even if they wanted to?
- dannyw 9y ago
  If you have private insurance, you can choose your own surgeon.
- ealexhudson 9y ago
  You can choose where to get treatment and who treats you; the main issue is whether you get the timeline you'd prefer. Generally, patients will choose a clinical center (to the extent that some hospitals have stopped offering specific treatments, because their stats were never good enough - e.g you need to do a certain number of children's heart ops per year to be good enough to get good stats). If you have the option to go private, either through your insurance or the NHS, then obviously there's another layer of choice. Most of the private surgeons are also NHS, anyway.
- SmellyGeekBoy 9y ago
  Yes, my father is currently undergoing treatment for cancer (involving multiple surgeries) and had issues with a surgeon. He was given the option to choose a different surgeon or even transfer to another hospital entirely.
- DanBC 9y ago
  It provides some. "Choose and Book" was introduced in 2004, and converted into e-referral in 2014, and it means you get a choice for most elective surgery. https://www.nhs.uk/NHSEngland/appointment-booking/Pages/about-the-referral-system.aspx https://www.nhs.uk/NHSEngland/appointment-booking/Pages/abou... https://www.england.nhs.uk/2014/05/choose-and-book/ https://www.england.nhs.uk/2014/05/choose-and-book/ Most people don't have enough information to make a sensible choice; and they don't understand the information they've got.

by aantix 9y ago

slap_shot 9y ago

Not sure why this is being downvoted. It’s a legitimate request. I worked for a novel medical device company and we had a lot of surgeons on staff. While not a product we’d ever build, there was always discussion amongst the doctors of how to better grade physicians and specifically surgeons. The concern is was that a lot, and I mean a LOT, of surgeons were bad at their job. They were always proposing different systems to evaluate surgeons, very close to what you described.

ItsMe000001 9y ago
> ... and colleagues would objectively assign a degree of difficulty score. He asks for a level of "objectivity" that you just can't get. What do you think medicine is? Like repairing toasters? "Why don't you simply assign some objective numbers" - it's so easy! No it is not, unless you only count a set of basic and routine procedures. Even things like a broken bone vary greatly - and then add the additional variance of the people having those broken bones. You can sort of get some objectivity when you do statistics of lots and lots of patients in many places over long periods - but the problem OP wants is to be able to make statements about individuals (doctors). Being able to say something about a population is very different from saying something about an individual within the population. "Statistics" about a single doctor are and will be full of randomness. Besides, if they did what I quoted from OPs statement above what would probably happen is that everybody declares everything as "very difficult" (or just below) expecting colleagues to do the same for them. In Germany private insurance has a multiplier on the amounts they can charge for something. Guess what: Everything is now declared as "very difficult" (with some short fuzzy explanation), multiplier 2.3. Almost nothing is charged at the "normal difficulty" rate. > Did they improve longevity? Did they improve quality of life? Given that each doctor is highly specialized, and that on the other hand your GP, the one who treats you long-term, can't actually do much when there is anything serious, those numbers are mostly out of the control of individual doctors. You would have to get such numbers system-wide, not per doctor. Medicine is supplied to patients throughout their life (incl. late life) by a network, not by an individual. There also is a huge impact of ones own life choices (e.g. obesity, smoking), and no, you can't just correct for them - not individually (for populations we can). All those numbers would look terrible for doctors who treat more of the worse cases. It would lead exactly to what the article is about. I'm not arguing against trying to measure surgeon outcomes - I'm against trying to use those measures for things they are not good for.
- aantix 9y ago
  The feedback would have to be anonymous. It’s the only way to get honest scoring.

carbocation 9y ago

What you're describing is commonly referred to as "propensity weighting." It is a good first step, though most of us think it still doesn't do a sufficient job of accounting for the risk of difficult cases.

sky_rw 9y ago

Does the NHS provide enough free market choice that anybody could take advantage of a score even if they wanted to?

dannyw 9y ago
If you have private insurance, you can choose your own surgeon.
ealexhudson 9y ago
You can choose where to get treatment and who treats you; the main issue is whether you get the timeline you'd prefer. Generally, patients will choose a clinical center (to the extent that some hospitals have stopped offering specific treatments, because their stats were never good enough - e.g you need to do a certain number of children's heart ops per year to be good enough to get good stats). If you have the option to go private, either through your insurance or the NHS, then obviously there's another layer of choice. Most of the private surgeons are also NHS, anyway.
SmellyGeekBoy 9y ago
Yes, my father is currently undergoing treatment for cancer (involving multiple surgeries) and had issues with a surgeon. He was given the option to choose a different surgeon or even transfer to another hospital entirely.
DanBC 9y ago
It provides some. "Choose and Book" was introduced in 2004, and converted into e-referral in 2014, and it means you get a choice for most elective surgery. https://www.nhs.uk/NHSEngland/appointment-booking/Pages/about-the-referral-system.aspx https://www.nhs.uk/NHSEngland/appointment-booking/Pages/abou... https://www.england.nhs.uk/2014/05/choose-and-book/ https://www.england.nhs.uk/2014/05/choose-and-book/ Most people don't have enough information to make a sensible choice; and they don't understand the information they've got.