Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Like it or not, the Surgeon Scorecard is the only game in town

David Mann, MD
Physician
July 25, 2015
Share
Tweet
Share

shutterstock_226271230

If you want to know who the best surgeon in the hospital is, ask the surgical nursing staff. If you want to know who does the best job opening up coronary arteries using catheters, balloons, and stents, ask the cardiac catheterization lab nurses and technicians.

Unfortunately, these approaches to comparing physicians’ skills are only available to hospital personnel. They are the only people who are in a position to compare the technical performance of many different doctors. This is not information the average patient can easily obtain.

The average patient has to rely on intangibles when trying to select a doctor. Fuzzy data such as bedside manner, self-confidence, board certification, waiting time for office visits and procedures, and word of mouth. Or, worse still, patients are told which doctor they have to see by their insurance company.  None of these methods of choosing a doctor is likely to have a high correlation with a doctor’s technical skill. There’s got to be a better way.

Along comes the Surgeon Scorecard, a web application published by ProPublica.

With the scorecard, it is possible to see raw complication rates of any surgeon (I’m sure the same data for cardiologists and other specialties is coming soon) in the United States who operates on Medicare patients. Pick any hospital and the individual complication percentages are displayed on a colored spectrum (green, yellow and pink on my screen) indicative of low, medium and high complication rates. An ominous red explanation point appears if one or more surgeons have complication rates in the pink zone. Click on individual surgeons and their data is shown in more detail, including numbers of procedures and 95 percent confidence limits (which frequently overlap more than one complication zone). Curiously, some surgeons with zero complications still have an adjusted complication rate in the medium range.

The publication of this database has unleashed somewhat of a Twitter and media storm, to the point that I’m not sure why I’m chiming in at all. Smarter people than I have complained about the methodology or have bemoaned the impact of all this on the practice of medicine. We are living in the era of big data, and data is only going to get bigger as it continues to accumulate in the ultimate garbage-in-garbage-out receptacle: electronic health records (EHR).

Unfortunately, the subtleties of statistics are lost on the average patient, who just looks at whether a surgeon falls into the green, yellow or pink zone on the complication rate spectrum. Given the negative PR potential of this data, it is likely that some surgeons will refuse to operate on high-risk patients, for fear of tainting their outcome data. So, as with quantum physics, Heisenberg’s uncertainty principal holds in the field of medicine, in that the attempt to measure outcomes may result in changing outcomes. Certainly the numbers will look better if high-risk patients are avoided. But will health care actually be better?  As was seen with EHR systems, the field of medicine’s square peg continues to be a difficult fit for computer technology’s round hole.

It is hard to argue against transparency, which seems axiomatically to be a good thing. There is no way to put the database genie back into the bottle. The only way to go forward is to make sure data collected is accurate and includes medical and demographic information about the population operated upon.  This will allow the data to be normalized as best as possible. All that data collection is a pain and a distraction. But patients want to know how good their doctor is, and right now the Surgeon Scorecard is the only game in town — unless you can corner a surgical nurse and get his or her honest opinion.

David Mann is a retired cardiac electrophysiologist and blogs at EP Studios.

Image credit: Shutterstock.com

Prev

An intern writes to his future self. See what he had to say.

July 24, 2015 Kevin 0
…
Next

How doctors can protect their online reputation

July 25, 2015 Kevin 0
…

Tagged as: Surgery

Post navigation

< Previous Post
An intern writes to his future self. See what he had to say.
Next Post >
How doctors can protect their online reputation

ADVERTISEMENT

More by David Mann, MD

  • It’s OK if doctors can’t memorize everything

    David Mann, MD
  • Watch what you say to patients

    David Mann, MD
  • What’s better: Narrative medical histories or checkboxes?

    David Mann, MD

Related Posts

  • Physicians who don’t play the social media game may be left behind

    Xrayvsn, MD
  • Why creative endeavors are important for the future surgeon

    Thomas L. Amburn
  • A physician’s addiction to social media

    Amanda Xi, MD
  • Paging the surgeon general: America needs you

    Linda Girgis, MD
  • Physicians and patients are now pawns in a political game

    Nicole M. King, MD
  • Skin-in-the-game doesn’t have to be scary

    Ronald Dixon, MD

More in Physician

  • What Beauty and the Beast taught me about risk

    Jayson Greenberg, MD
  • Creating safe, authentic group experiences

    Diane W. Shannon, MD, MPH
  • How tragedy shaped a medical career

    Ronald L. Lindsay, MD
  • A doctor’s guide to preparing for your death

    Joseph Pepe, MD
  • How policy and stigma block addiction treatment

    Mariana Ndrio, MD
  • Why don’t women in medicine support each other?

    Jessie Mahoney, MD
  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • What Beauty and the Beast taught me about risk

      Jayson Greenberg, MD | Physician
    • Creating safe, authentic group experiences

      Diane W. Shannon, MD, MPH | Physician
    • The diseconomics of scale: How Indian pharma’s race to scale backfires on U.S. patients

      Adwait Chafale | Meds
    • Healing from medical training by learning to trust your body again [PODCAST]

      The Podcast by KevinMD | Podcast
    • How tragedy shaped a medical career

      Ronald L. Lindsay, MD | Physician
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • What Beauty and the Beast taught me about risk

      Jayson Greenberg, MD | Physician
    • Creating safe, authentic group experiences

      Diane W. Shannon, MD, MPH | Physician
    • The diseconomics of scale: How Indian pharma’s race to scale backfires on U.S. patients

      Adwait Chafale | Meds
    • Healing from medical training by learning to trust your body again [PODCAST]

      The Podcast by KevinMD | Podcast
    • How tragedy shaped a medical career

      Ronald L. Lindsay, MD | Physician
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Like it or not, the Surgeon Scorecard is the only game in town
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...