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Ultimately, we need to compare apples to apples by building rating systems that account for the difficulty of treating patients with various, ailments at variou
by crusso 8y ago
Ultimately, we need to compare apples to apples by building rating systems that account for the difficulty of treating patients with various, ailments at various ages, with various complications.
Think of it in terms of competitive diving, gymnastics, or snowboarding: Your scores depend upon the difficulty of the moves you attempted combined with your performance of those specific moves. The more difficult the move, the more you're compensated for even attempting it when it comes to scoring.
The trick then is to prevent physicians from gaming the system by exaggerating the difficulty of the patients they're dealing with. You'd need to use as many objective metrics as possible and possibly some system of having different physicians assess ratings than the ones performing the procedures - maybe in some kind of double-blind fashion to prevent any kind of coordination strategy.
- calcifer 8y ago> some system of having different physicians assess ratings than the ones performing the procedures - maybe in some kind of double-blind fashion to prevent any kind of coordination strategy. That would simply result in an unwritten rule where everyone gives everyone else good ratings.
- fricat1ve 8y agoThe "objective metrics" part is key. Medical records are generally written in a way that weaves a standard narrative of the doctor as either a hero/savior or a valiant defender of a lost cause. Doctors only get investigated when derogatory facts accumulate to an extent that this "standard narrative" collapses. It's not really an objective or scientific standard.
- vannevar 8y agoThe article itself alludes to a 'EuroSCORE' that purports to rate the risk of mortality beforehand. It seems like the mortality ratings should be risk-adjusted. A double-blind system as you suggest could work like this: First, the rating system would be opt-in on the part of the participating surgeons. It seems likely that patients would prefer rated surgeons, so there would be an incentive to participate but it would not be mandatory. Those who belonged to the rating body would be required to do anonymous risk assessment on some number of cases per month. They wouldn't know who the patients are or who is treating them, they would only get anonymized records. Their risk assessments would be calibrated in the short run against other assessments, and in the long run against outcomes. These calibrated risk assessments would be used to adjust the score of the treating surgeon on the outcome, so that they would be penalized less for mortality in patients with a very high assessed risk.