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LETTERS: Ian S Gilfillan Ranking heart surgeons has pitfalls BMJ 2003; 327: 107-b [Full text]

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Are league tables a means of rationing?

Mike P Rodger   (1 August 2003)

Are league tables a means of rationing? 1 August 2003
Mike P Rodger, Regimental Medical Officer 23 Sqn 16 Close Support Medical Regt Send response to journal: Re: Are league tables a means of rationing?	Sir - Gilfillan appears distressed that the publication of league tables of cardio-thoracic surgeons performance will prevent surgeons from operating on high-risk cardio-thoracic cases. Given that we can assume that surgeons wish to keep themselves busy it appears likely that surgeons would operate on low-risk cardio-thoracic cases instead. I imagine that low-risk cases incur fewer post operative complications and therefore require less post operative resources than high risk cases. I imagine the operating time is less per low-risk case thus operating lists could include more cases per session, notwithstanding the dearth of ITU beds. Thus, it is logical to conclude that the shift of emphasis from operating on high-risk cardio-thoracic cases to low-risk cases buys more operations with lower morbidity for our resources. Anecdotally most patients are initially people with mild cardio- thoracic disease who need a low risk operation but because of waiting lists must wait until they are 'sick enough' (but not too sick nor dead) to need a now high-risk operation, with poorer outcomes. Would these people be better served by an operation early or a last ditch high risk operation? Competing interests:   None declared