Ranking heart surgeons has pitfalls

doi:10.1136/bmj.327.7406.107-b

BMJ 2003;327:107 (12 July), doi:10.1136/bmj.327.7406.107-b

Letter

Ranking heart surgeons has pitfalls

The first 150 words of the full text of this article appear below.

EDITOR—Dyer reports that heart surgeons are to be rated according to success in bypass surgery.¹ Cardiac surgery isa team sport, and each player can influence the score. The dilemma I face as a surgeon is that the result is mine, although thepoor performance may not always be.

Furthermore, the potential problems with ranking cardiac surgical performance have been well described previously.

The cardiac surgery reporting system was mandated for all cardiacsurgeons in New York State by its department of health in 1989.It was the first doctor specific mortality report published.As a result of successful application under freedom of informationlegislation by Newsday, both institutional and individual outcomeshave appeared in the popular press from 1991.

Burack et al reported in 1999 that 40% of surgeons admittedto gaming with risk factors, and that 62% admitted to refusingto operate on high risk patients . . . [Full text of this article]

Ian S Gilfillan, cardiothoracic surgeon

Fremantle Hospital, Fremantle, WA 6160, Australia ian.gilfillan@health.wa.gov.au