Call for surgeon report cards

REPORT cards for surgeons showing patient death rates should be introduced to help people make decisions about which doctor to choose for an operation.

REPORT cards for surgeons showing patient death rates should be introduced to help people make decisions about which doctor to choose for an operation.

The recommendation from bioethics expert Justin Oakley includes making mortality rates available to the public on an internet database that lists every surgeon and hospital in Australia.

Professor Oakley, from Melbourne's Monash University, has called on federal and state governments to help fund the development of a public reporting system following the Bundaberg Hospital scandal, in which Jayant Patel was linked to at least a dozen deaths and dozens of injuries through incompetence.

Professor Oakley said the national database should start with report cards for cardiac surgeons, a system that has recently been set up in Britain. It should then be expanded to include all surgeons.

He said the report cards, which could also include surgery complication rates, would keep surgeons more accountable to the public.

"The mortality rates of each surgeon should be made available to patients so they have a better idea of their surgeon's track record," Professor Oakley said.

"It also improves the safety and quality of care. If surgeons know their performance will be seen by the community, that is a powerful incentive for surgeons to maintain their performance."

The Patel scandal at Bundaberg Hospital had shown that internal peer review was not enough to keep the profession accountable, he said.

Professor Oakley, who heads Monash's Centre of Human Bioethics, said any mortality rate for surgeons would have to be adjusted based on the risk of the operation.

"They would adjust the mortality rate depending on the mixture of patients," he said.

"It would take into account patient profile. If a surgeon performs on a lot of patients that are high risk, like those that are a bit sicker or older, that is factored in to the rate."

Professor Oakley, who has co-edited a book on the subject due out in August, said governments would need to invest significant resources to make a report card system viable and it should be set up sooner rather than later.

"I don't think we should wait for a scandal to occur to allow patients to get access to the track records of surgeons," he said.

However, Royal Australasian College of Surgeons president Andrew Sutherland said there were immense practical difficulties in implementing report cards, calculating a mortality rate and making risk adjustment.

"It's a terrific idea but the risk assessment (of mortality rates) is very difficult," he said. Factors such as high-risk operations would make it almost impossible to determine a fair rating.

"We are totally against report cards because there is so much opportunity for unfairness," Dr Sutherland said.

"The practicalities are not possible at this time."

Dr Sutherland said the college had started conducting audits of surgery deaths in some states and said there were plans to expand the program nationally.

Deaths were reviewed by specialists with the aim of trying to prevent problems from recurring, but the findings were not made public, he said. "Pretty soon we'll have an audit of surgical mortality in every state."