12 Apr 2015

Call to publicise doctors' performance data

7:29 pm on 12 April 2015

A senior Auckland doctor says New Zealand is years behind other key countries in telling the public how well individual surgeons do their job.

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David Grayson said DHBs were getting hammered for information about the performance of their doctors. Photo: RNZ / Diego Opatowski

David Grayson says that has caused frustration and district health boards are under mounting pressure to release such performance data.

It comes as doctors' regulatory body, the Medical Council, calls for a major debate about the sensitive information, which typically includes data about volumes of surgery performed by surgeons, revision rates and risk-adjusted death rates following surgery.

The information is the sort that many patients would like to know but find they cannot ask for.

The consumer leader at the Health Quality and Safety Commission, Chris Walsh, admits to being nervous when she faced a surgeon for a mastectomy.

"Apart from all the anxiety that I was going through and all the stress, I looked at him and I thought to myself, I don't know you, I've never met you before. Who are you and how good are you at what you do?"

Marlborough woman Lynn Weir is also nervous following the death of her sister Rachel Riddell following gallbladder surgery several years ago.

"We ask more questions about who's going to fix our cars than we do about someone who we're putting our life into their hands," she said.

Medical Council chairman Andrew Connolly.

Medical Council chairman Andrew Connolly. Photo: Supplied

The Medical Council said in a discussion paper that Ombudsman Ron Paterson ruled late last year that Tairawhiti District Health Board should release surgeon-specific case volume data.

It said it was also aware of further requests of a similar nature from various media outlets to DHBs under the Official Information Act.

Council chairman Andrew Connolly said league tables, which could be compiled with such information, were misleading.

"If we go and put out just a league table that simply says six deaths out of 250, you know six for 250, a bit like a cricket score, it is frankly meaningless," he said.

"It doesn't tell us if the expected mortality of that group because they were so ill would have been 15, in which case the surgeon and the hospital are doing fantastic jobs."

He said understanding the context was vital, and many people were unable to choose their surgeon anyway.

DHBs "hammered" for information

However, Counties Manukau DHB surgeon and leader in patient safety and innovation, David Grayson, said the United States released performance data on individual doctors two decades ago, and Britain's National Health Service also puts risk-adjusted, non-ranked information online.

"People feel that they're going to be judged by this data and information that people see. But that's the wrong end of the stick.

"We should be saying, 'OK this is all the information that we have, collectively, and that's both all the healthcare providers and the public themselves. This is what we're after, we're after trying to improve things."

Dr Grayson said DHBs should learn from Britain and America, and work together on how to provide public access to performance data.

All groups involved needed to agree what information to make public initially, he said.

"We could just start out slow and do the simple stuff first and get more detail as we get more confidence in how it's going."

He said in the meantime DHBs were "getting hammered" for information, and not just from journalists.

The Health Ministry's chief medical officer Don Mackie said the ministry was working with the sector on the issue.

"We're thinking about how we do this in the best way and the Medical Council paper is one of the pieces of this combined work between the Ministry of Health, Council of Medical Colleges particularly and the Medical Council to actually work our way through what the most useful way of presenting outcome data is for both the public and for the profession."

Dr Mackie said the data did need a context provided with it, as was done over the release of sensitive information about hospital mistakes - so-called Serious and Sentinel Events - following an Official Information Act request from the media in 2009.

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