Consultant outcome data – GP skit

Terence needs a bowel resection for cancer. This was found at colonoscopy as part of his company’s health insurance policy . His GP has referred him to Miss Emma Thomas, a colorectal surgeon at the local Trust. Terence has looked her up on the new NHS England ‘Consultant outcome data’ website. He has some concerns.

 

In the GP surgery 

Terence: “I looked her up. I’ve got some questions.”

GP: “Go ahead.”

“Right. I looked her up by name, and it said that her mortality rate was ‘OK’ – which I assume means acceptable, safe…”

transpidity base

“Good.”

“But when I clicked on the ‘source data’ it showed all the surgeons in the hospital, and Miss Thomas’s adjusted 90 day mortality rate (I think I understand that) was 8 or something… whereas some of the others were much lower, between 1 and 3. It made me think, I want to have my operation done by one of those.”

transpidity colleagues

“Right. Right. Well…”

“So can you re-refer me? I haven’t actually seen her yet.”

“It’s not that easy actually.”

“It is my choice isn’t it.”

“It is. Certainly. But let me explain… this data is helpful, but I think it’s the outliers you really have to look out for. And Miss Thomas is certainly not an outlier. She’s very good. And very nice to her patients.”

“But she’s had 4 deaths, based on 70 operations… while the best one in that group has had only 2, out of 90! I don’t want to be number 5. It’s obvious.”

“It may be that her colleagues have operated on less sick patients.”

“It’s adjusted isn’t it?”

“It is, you’re right. But those deaths, they are within the expected, or acceptable range.”

“Not to the ones who died, surely.”

“No. Sadly though, some deaths must be expected in patients with serious bowel problems. Sometimes they come to hospital as emergencies in a terrible state, with infections or obstruction, and they can be very frail…”

“So you think Miss Thomas has had more than her fair share of those?”

“I can’t say…”

“Or just a bad run of luck?”

“Well… who knows?”

“If you don’t mind I’d rather not be operated on by her until that run of luck has run its course.”

“Terence, this data.. I’m not sure if it’s really designed for such detailed scrutiny. The basic fact is, all the colorectal surgeons in that hospital are good…”

“Some are better than others though…”

“The more experienced ones, possibly…”

“Is Miss Thomas new then?”

“She is the newest, but she’s been there for 18 months.”

“Still on her learning curve? So you are asking me to agree to being put on that learning curve?”

“No. She’s fully qualified.”

“The older ones must be better. It makes sense.”

“They are a team, they collaborate, advise each other. You will be cared for by the whole department. The hospital as a whole does very well when you look at the graph of all the Trusts in the area. You saw that?”

transpidity trust

“I did. It takes you to a secondary website, coloproc- something.”

“Exactly. Your ‘outcome’ will depend more on how the unit is run as a whole than your individual surgeon’s skill…”

“Really? You mean that?”

“I do. This isn’t eyewash.”

“But doctor… who would you want to do your operation? Or one of your parents?”

“I understand completely what you are saying Terence. I would instinctively go for the one with the lowest number, of course, but as a doctor, as someone who worked in surgical units as a trainee, I know that it’s often more about the general quality of care you receive. There are surgeons who are technically questionable, but there are lots of systems in place to identify those… and as I said, if one was an outlier on this website I would steer clear. But the mortality limit has been set for a reason here, and if your surgeon is below that limit then you should be confident that your treatment will be acceptable.”

“If not the best?”

“We can’t all have the best all the time.”

“Just average then?”

“Average is good, sometimes. Acceptable is… acceptable.”

“Average is average, surely. And below average is… ‘OK’”

“It’s…”

“It’s what I must settle for.”

“I really…”

“I know. I’ve taken up enough of your time. Thank you.”

 

 

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