Lenin
01-12-2005, 01:31 PM
Yesterday's NY Times reported on a disturbing trend in New York. The state has taken the lead in letting patients have information they need. As one of the first steps, the state has established a large database listing EVERY ANGIOPLASTY and EVERY DOCTOR who performs them and in WHICH HOSPITAL and the percent of DEATHS for each. Ancillary is the fact that New York State has the HIGHEST survival rate in the nation.
As a result, the on-line database allows a person to find the best doctor and the best hospital in his area, or indeed anywhere in the state that he can get to conveniently.
So far so good.
Yesterday's article discussed a survey among cardiologists and 83% said they thought as a result of the database, people who could benefit from the procedure were NOT getting it.
The problem arises because chance of death as an elective surgery is less than 1% but as an emergency case, with a heart attack or shock, the chances of death approaches 60%. If these people are angioplastied, chance of death is 50%. Thus since many patients will inevitably die, the doctor may avoid the procedure so he doesn't get a BAD MARK consigning perhaps 10% to the morgue unnecessarily.
There's also a discussion that the doctors who do the procedure infrequently are the most averse to taking a risky patient because one death skews his "score" markedly.
The whole thing is APPALLING.
(All statistics are as reported in the Times, rather than anything I dug up.)
As if this isn't bad enough, I'm loathe to add my thought that of course the very best scores would be achieved by doctors who angioplastied completely healthy hearts...nobody could be THAT callous outside of a horror movie, I hope.
As a result, the on-line database allows a person to find the best doctor and the best hospital in his area, or indeed anywhere in the state that he can get to conveniently.
So far so good.
Yesterday's article discussed a survey among cardiologists and 83% said they thought as a result of the database, people who could benefit from the procedure were NOT getting it.
The problem arises because chance of death as an elective surgery is less than 1% but as an emergency case, with a heart attack or shock, the chances of death approaches 60%. If these people are angioplastied, chance of death is 50%. Thus since many patients will inevitably die, the doctor may avoid the procedure so he doesn't get a BAD MARK consigning perhaps 10% to the morgue unnecessarily.
There's also a discussion that the doctors who do the procedure infrequently are the most averse to taking a risky patient because one death skews his "score" markedly.
The whole thing is APPALLING.
(All statistics are as reported in the Times, rather than anything I dug up.)
As if this isn't bad enough, I'm loathe to add my thought that of course the very best scores would be achieved by doctors who angioplastied completely healthy hearts...nobody could be THAT callous outside of a horror movie, I hope.