Have you ever consulted Consumer Reports before buying a new appliance or car? I have. Now you can pick up the latest issue (September 7, 2010) and decide where, among the 221 centers that participated, you'd like to have your coronary artery bypass grafting (CABG) surgery performed.
Rick opines in the podcast (and btw, also agrees with the editorialists in the New England Journal of Medicine) that this is a seminal event in medicine, and that the Society of Thoracic Surgeons (STS) deserves kudos for compiling and crunching this data. The story is this: beginning in 1989 the STS began to gather data on many aspects of cardiac surgery, including coexisting medical conditions in their patients, rates of death, use of medications, complications, and surgical techniques. They analyzed and refined their methods with the objective of improving the standard of care for all concerned. Wow! That's what medicine is supposed to do!
Now Consumer Reports has compiled a rating system using stars that depends on 11 of these performance measures. One, two or three stars are awarded depending on these factors. Actual scores on four of the subcategories can also been seen.
What's good about this? I think it helps patients become more informed, and therefore better at participating in decisions related to their own medical care. Rick believes the real benefit lies in allowing standards against which all programs can be measured to be developed and assessed. For programs that fall short it provides a benchmark for improvement.
One concern is that critics may say we don't have physician or surgeon-specific scores and can't compare individuals, but Rick points out that early attempts to rate physicians in this way had the undesirable result of causing them to refuse difficult cases in order to avoid compromising their scores. Program wide ratings may largely avoid this problem.
The STS program and willingness to reveal data to a large consumer magazine provides new transparency in medicine that will hopefully encourage adoption of such methods in many more medical arenas.
Other topics this week include differences in patient and physician expectations when it comes to stent placement in the issue of Annals of Internal Medicine, the risks of carotid stenting in those over 70 in the Lancet, and sleep and obesity in kids in Archives of Pediatric and Adolescent Medicine. Until next week,y'all live well.