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[–] Karkrash66 0 points 1 point (+1|-0) ago 

I definitely agree with the concept, but unfortunately surgery completion is a much more complex issue and this app is really oversimplifying it. Ultimately, the main problem is that the laymen simply doesn't understand the complexity and hidden factors that rule whether a surgery is successful or not and why. An alternate method of dealing with this potential method is having better oversight from medical communities themselves, which from my knowledge is pretty damn good already.

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[–] albinoblackbird 0 points 1 point (+1|-0) ago 

"Oh, wow, what does this thing do? Gee, this looks sharp, doesn't it?"

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[–] Dudas 0 points 1 point (+1|-0) ago  (edited ago)

Ok, so now surgeons will just flat-out refuse to operate on people who smoke, people with diabetes, people who are overweight or obese, people with clotting problems, alcoholics, people who abuse narcotics, people with immune disorders, people with heart/kidney/liver problems, or people with any other prior conditions that might increase complications.

When the government began toying with the idea of tying medicare reimbursements to procedure outcomes, a lot of doctors started refusing to operate on patients who were at high risk for complications. It sounds really cold, but at the end of the day you can't blame them for refusing to jeopardize their businesses because of someone else's poor life decisions that led them to such a state of illness.

EDIT: Yeah, what @bayesianqueer said!

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[–] Ilvi 0 points 1 point (+1|-0) ago 

Really? Business over humanity? O.O

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[–] Dudas ago  (edited ago)

Yes, really... but it's not as bad as all that.

It's not like the docs are in the E.R. saying, "No, this fatty bleeding out on the table is going to fuck up my S/D ratio! I'm not touching it!" It's more like a guy comes into the office needing their hernia fixed (not an emergency), and the docs are saying, "Stop smoking, lose 30 lbs, and come back in 2 months and we'll schedule surgery right away. If you don't do those things, don't bother coming back in here. You can find someone else."

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[–] bayesianqueer 0 points 15 points (+15|-0) ago 

The problem with this is that you can only adjust so much. If you look at the community hospital where I practice in CA, it looks better with regard to complication rates than Brigham and Women's Hospital and the Mayo Clinic. Now I'm not saying I work at a bad hospital, but seriously. We aren't that good. However Mayo and the Brigham take patients for surgeries that the surgeons at my hospital wouldn't touch with a ten foot pole. Moreover the best orthopedist at my hospital scores more poorly than the one who refuses to take call and cherry picks his patients.

The problem is that measuring quality is exceedingly hard. There are some measures that seem objective but which can still be gamed and will often make surgeons who do the right thing (i.e. take call and get the luck of the draw for his/her patients versus only do elective cases that they can pre-select for patients less likely to have complications.) Moreover the difference in some of their categories that makes one low versus high can be as little as 1%. That amount of difference is easily within the fudge room of patient selection.

Unfortunately I don't have a solution to assess physicians and neither has any that I have come by (and I chair my hospital's quality committee, so I am aware of ALL the measures used by CMS and other agencies).

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[–] Digik 0 points 1 point (+1|-0) ago 

I agree, but think we still have to try to define something. For one, to measure, could you separate out the primary reason for a surgery from common complications (e.g. post-surgery infection rates...). Or group performance ratings between common levels of difficulties... physicians into front line care and second and third level experts (those physicians that get referred to from other doctors when they hesitate to take on a problem...)

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[–] 1123581321345589144b 0 points 1 point (+1|-0) ago 

It's about time we start holding healthcare accountable for its service. This industry has enjoyed near immunity to the backlash associated with bad performance. This is much like the ACA holding hospitals accountable for atrocious relaps rates and insurance companies accountable for dropping people once they got sick or refusing to insure people with existing maladies. Good. Sometimes we need govt regulation. Yet all the deep pockets fervently spew misinformation to limit these types of control so their pockets stay deep.