In our modern-day world, American consumers will routinely compare shop for everything they need. Analyzing product reviews to guide the smallest online purchases, spending time dissecting ratings to choose the perfect restaurant, or thoroughly investigating amenities and offerings before settling on a hotel or cruise ship. However, intriguingly, this habituated comparison-shopping culture doesn’t appear to extend to the healthcare industry, specifically when it comes to choosing a surgeon for major procedures.
Many Americans don’t know that it is not only possible but highly advantageous to shop around for the best surgical care. More often than not, they tend to rely on referrals from their primary care physicians or recommendations from their social circle. While these referrals are made with the best intentions, they may not necessarily reflect the skills and performance of the surgeon suggested.
This presents an issue as research consistently indicates significant variation in outcomes for the same procedure across different hospitals, and even among different surgeons within the same hospital network. Patients should be privy to this data, empowering them to make informed decisions about their medical care. Several studies underline the importance of this.
One monumental study by the New England Journal of Medicine revealed that patients who underwent high-risk procedures at hospitals that infrequently performed those operations encountered significantly higher mortality rates. This disparity in rates could even reach up to 12% for certain procedures. Similarly, patients having joint replacements at low-volume hospitals were reported to have an approximately 33% greater chance of complications compared to patients at high-volume hospitals.
But these discrepancies are not just at the hospital level; they exist amongst individual surgeons as well. A notion commonly accepted in athletics, ‘practice makes perfect,’ is equally applicable in the medical field. Particularly in orthopedics, the substantial benefits of an experienced surgeon become evident post-procedure: patients experience fewer complications and infections, and undergo fewer revision surgeries, leading to smoother recoveries.
A recent examination of 12 studies illustrated how patients who had shoulder surgeries with surgeons doing it frequently had lower rates of repeat surgery and hospital readmissions. It’s been shown that surgical skill alone can account for more than a quarter of the variation in complications rates among surgeons. Despite the significant implications these findings bear on their health, many patients remain unaware of this data. This lack of awareness is lamentable because most medical professionals, particularly surgeons, value an open conversation with their patients about their expertise and outcomes.
Before undergoing a major surgical procedure, it is advisable for patients to ask their surgeons three key questions: How many times they have performed the suggested procedure in the past year to assess their proficiency? Volume is significantly tied to outcomes. Inquiry around infection and complication rates, readmission or need for revision surgery is valid, as every surgery carries risks and these risks are not universally consistent. How do the surgeon’s outcomes compare with national benchmarks? Surgeons dedicated to quality review and research should be capable of answering this. Lack of an appropriate response provides valuable insight. How do they stay updated on best practices in medicine? Medicine is a rapidly evolving field.
Surgeons engaged in research, teaching, or participating in specialty conferences are more likely to maintain a performance review and implement improvements. This immersion into their field is shown to be consequential, as seen in an analysis of a newly adopted colonoscopy technique, where variation in complication rates between physicians was almost double, a far more significant variation than seen with the traditional colonoscopy technique. It is beneficial for patients, when feasible, to consider academic medical centers, which usually prioritize data tracking, peer review, and continuous quality improvement.
While many skilled surgeons operate outside of these environments, they are more likely to rigorously measure outcomes and systematically integrate new research into their practices. However, the onus should not solely rest on patients to decipher this critical information question by question. Hospitals and healthcare systems need to publicly share data on complications rate, readmissions, revision surgeries, and patient-reported recovery metrics, much like car crash-test ratings are available for consumers.
Patients should have the liberty to compare and assess surgical performance data before they make significant medical decisions. Not only would this increased transparency empower patients, but it would also foster improvement in the healthcare system. Public reporting inspires improvement, reduces preventable complications, and results in a reduction of costs for patients, their families, employers, and insurers alike.
Americans have made it routine to refer to reviews before committing to a meal at a restaurant, this same principle needs to be extended to the more life-altering decision-making processes in healthcare, so patients can comprehensively compare their physicians and hospitals. The healthcare system plays a significant role in initiating this paradigm shift, to proactively furnish patients with the evidence they need to make an informed decision about their care. Patients deserve none less.