Intended for healthcare professionals

Education And Debate

Half of all doctors are below average

BMJ 1998; 316 doi: (Published 06 June 1998) Cite this as: BMJ 1998;316:1734
  1. Jan Poloniecki, lecturer (
  1. Public Health Sciences, St George's Hospital Medical School, London SW17 0RE
  • Accepted 26 March 1998

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A heart operation can put a very ill patient on the road to a long and healthy life, or it can kill the patient. Major surgery is just one of many instances when treatment can result in a failure more serious than the consequences of doing nothing. The balance of risk requires a responsible attitude from all the many parties to an operation: the patient, the general practitioner, the specialist physician, the surgeon, theatre nurses, and the anaesthetist; supervisors, such as the chief medical officer and chief executive of the hospital; and the funders of the operation.

This article considers the advantages of having an authoritative estimate of the current failure rate for an operation and reflects on the problems that have arisen where there was a lack of interest in doing this.

Summary points

Even if all surgeons are equally good, about half will have below average results, one will have the worst results, and the worst results will be a long way below average

With imperfect allowance for differences in case mix, differences in performance figures for surgeons or hospitals do not necessarily reflect differences in risk to an individual patient

All prospective parties to a major operation should have access to a numerical estimate of the risk of the patient not surviving

What are my chances, Doc-as a percentage, please?

A numerical estimate of the failure rate is a number, not a statement like “The operation is nearly always successful.” It is also a single number, not a range like “5-20%.” The estimate should relate to the doctor who will perform the operation, and it should be a current estimate, especially if there have been recent failures. It will be different from the national average for last year, and from the rates for other surgeons at the same hospital. The source of the estimate …

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