How Safe is Your Doctor?

Patients planning to undergo major complicated procedures such as heart surgery, organ transplantation or joint replacement are often anxious to know about the success rates and risks, before making up their minds or choosing the doctor.

Conventionally it has been the word of mouth. “ We heard Mr Sharma, our neighbour’s friend, came home well after a heart surgery in X hospital by Y surgeon. He must therefore be good” is the usual formula.

Another method has been to assess a doctor’s competence by seeing the crowd outside his chamber. I remember one Mr Jaiswal who had come to consult me at SGPGI in our opening days in 1987 telling me candidly, “ Most successful doctors in the city have crowds  waiting outside their clinics and they spend 2 minutes per patient, while you spent 30 minutes on me and don’t seem to have any one else waiting outside!”.  He therefore did not think me competent and could not muster up enough confidence to undergo an endoscopy by me at that time.

In these days of computers and internet, the commonest thing smart people do is search the net. This approach however has its own set of problems.

We are led to believe that more hits on Google are more likely to be valuable. It is therefore hardly surprising that corporate hospitals and private doctors have an overwhelmingly larger presence on the net than highly skilled specialists in academic and government institutions, who did not make the effort to promote themselves.

Effort is on in some countries to encourage hospitals and departments to put up data on the internet, stating for instance, how many open heart surgeries have been done, how many have been successful and how many succumbed. It is hoped that this kind of transparency will help patient make better informed choices.

The genesis of this initiative dates back3 decades when a whistle blower drew attention to an alarmingly high rate of deaths in children undergoing heart surgery in a hospital in England. Now known as the Bristol Heart Case, it was revealed that 29 of 53 children who had undergone a type of heart surgery at the Bristol Royal Infirmary during a particular period had died, the mortality rate (55%) being much higher than had been the experience of other similar centres.

As a consequence of this revelation by the inquiry conducted by the National Health Services of UK, the names of Dr James Wisheart, Dr John Roylance and Dr Janardhan Dhasmana were struck off from the council list and they were debarred from operating.

Indeed, if authentic data about a doctor’s experience, success rates and complications were made available, decision making for patients would become far easier. But with corporate hospitals out there to do business, ensuring authenticity of data could be a real challenge.

The word of mouthor neighbour’s advice may still have a place and be very valuable!

As published in HT City ( Hindustan Times) dated 25 August, 2013.