Death Rating of Doctors Hurting Healthcare? Study highlights complex issue

The statement of purpose for this blog pulls no punches. From my choice of words the reader can easily deduce that I am "mad as hell" and often ask myself how much more I can take. However, I fully recognize that the challenge of improving health care is, like most challenges we face today, complex and far from clear-cut. Sure, there are some things that ARE clear, at least IMHO, starting with television adverts for drugs. They don't help anyone but the shareholders of drug companies. Drug ads on TV should be banned. The laws that prevented them for so many decades should re-applied. Period. Do a little free reading here if you doubt this or dig into some of the scientific papers here.

But other issues are less clear cut. For example, should the public have access to a doctor's 'stats' such as survival rates for individual surgeons. This sounds like it might be a good idea. If I was about to have major surgery I would like to get some assurance that the doctor wielding the knife had a good track record. Indeed, a good friend of mine is facing hip surgery and found a set of stats in USAtoday that gave him pause. He was going to have the surgery done at Flagler Hospital in Saint Augustine, but Flagler only got one star in the ratings he found on the web, versus four stars at the hospital he chose instead. However, these ratings are tricky. Consider this chart. Flagler gets three stars for 2007, an improvement over one star for 2006.

Not knowing who or what stats to believe is only part of the problem. Consider this story in the Boston Globe about death rating doctors. And now consider this comment by Twila Brase, president of the Citizens' Council on Health Care:

"Physician report cards threaten patient access to medical treatment. Doctors who fear that the death of a patient will be a black mark against them have been found to avoid the patients that need them the most. Increasingly, patients may find doctors unwilling to try a risky procedure that could actually save them."
I don't always agree with Twila, but have remained on her mailing list because she often highlights the other side of the coin, so to speak. The CCHC web site is certainly worth a look.

As for the answers, well it seems to me that under a free market system anyone can get a good rating for their product or service, they just have to find the right rating entity, and invent one if there is not a pliant one to be found. Wouldn't a government rating system be better? After all, we get government crash test ratings for our cars. And would it not be better for those ratings to apply to a surgical practice as a whole, rather than single out individual doctors? Further research on the effect that Twila highlights is clearly needed.

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