Monday, March 03, 2008

Hospitals are dangerous places

According to conservative estimates between 2-4% of hospital patients fall victim to doctors’ mistakes. In Germany every year between 340,000 and 680,000 patients are affected by such errors. At least 17,000 patients die in that country each year because of doctors’ errors. Compare that to the about 5,000 people who die in Germany in traffic accidents per year. No doubt, sub-optimal health care is a dangerous business. Equally, though, mistakes are all too human. They are obviously of greater consequence in some professions than in others.

W Five’s investigative team broadcasted last Saturday allegations about professional failings of a surgeon at Scarborough General Hospital. Some of these allegations seem to have been well-founded, because the surgeon in question is these days restricted in terms of the work he is able to perform at the hospital. The program makers went further. They demanded that patients should be able to access individual surgeons’ records of success and failure rates. After seeing the program and listening to truly heart-wrenching stories, anyone’s gut feeling would likely be that such disclosure is not unreasonable. After all, wouldn’t we all want to improve our odds if we had to undergo surgery? Surely, none of us would volunteer knowingly to be operated on by the worst-performing surgeon of any hospital department, or would we?

The ethical argument underpinning this demand is essentially that for any patient to give truly autonomous informed consent to any medical procedure she needs to know anything that is reasonably material to informed decision-making. One could argue that information about a given doctors’ failure rates is very much materially relevant to informed decision-making. Admittedly, a reasonable person likely would want to know. And yet, I remain skeptical about this solution. It seems, once we were to receive such information we would be sliding down a slippery slope that strips our health care professionals of much of the same rights to a kind of professional type of privacy that we take for granted for ourselves. Why not ask our doctors to also disclose any health problems they might have that might pose a risk to us during surgery? Do they suffer from infectious illnesses (we might not trust the efficacy of universal precautions)? Should we not test them prior to surgery and display that information on posters throughout the hospital and on the internet? Should we enforce psychological testing prior to surgery to ensure that no spousal dramas affect the on- the-job performance? Why not also have public report cards on the maintenance of the hospital equipment, cleanliness and so on and so forth? There does not seem to be a clear line that can be drawn in the sand on this issue, once we start going down the track proposed by W Five’s investigative journalists.

When we board a train, do we expect displays indicating how often the train driver erred during his career? Do we check when we board a transatlantic flight how old the plane is, or whether the pilot and captain have a history of heart problems?
Most of us don’t bother undertaking such detective work, and we don’t expect such information to be reasonably available to us. Nothing less, however is being proposed for doctors. When you think about planes and pilots (indeed, bus drivers!) many more lives are at stake, yet our inquisitive minds are at peace in the knowledge that regulatory agencies will ensure that the bus driver is well trained, and that the equipment she uses is in top condition. Government and statutory bodies like the Ontario College of Surgeons and Physicians look after the quality of our doctors and have checks and balances in place that ensure that individual professionals failing us are found out and properly dealt with. So it should be. This much the professions and our professionals owe us as society.
The real issue then should arguably not be to keep publicly track of individual performances, but to ensure that hospitals act fast when individual professionals’ performances are suboptimal. Scarborough General Hospital clearly failed on this count, if the information on the W Five program is to be trusted. It is also worth asking how we can ensure that the College of Surgeons and Physicians moves faster than it has in the case highlighted on W Five. It is a perennial problem of such bodies the world all over that many citizens and indeed, many professionals think that they are more concerned to cover up for colleagues under scrutiny then to keep the interests of individual patients, clients and society at large at heart. This constitutes a serious threat to the professions and the trust society has invested in them. It is government’s responsibility to ensure that institutions like the Ontario College of Surgeons and Physicians deliver on that front, and do so in a transparent manner.

The current demands for the public availability of individual doctors’ performance data are missing the point. Patients should not ever find themselves in a situation where such data would make a difference, because the offending professionals should be out of their jobs way before that information would be on display. That is the real regulatory issue.

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