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The legacy of Bristol: public disclosure of individual surgeons' results (with 5 co-authors)

David Spiegelhalter · 19 Aug 2004 · doi.org

5 korrents from this paper

In plain words

After Bristol, heart surgeons set out to publish each one's raw death rates inside very wide safety bands to show they are safe, not to help patients pick a surgeon. This will be the first UK surgical specialty to review named individuals publicly, opening the door for other branches of medicine and debate on surgeon versus whole-hospital responsibility. It argues a position and proposes a method using three years of crude death rates against 99.99 percent limits, building on Bristol recommendations while resisting US-style adjusted comparisons.

Our summary of the paper, not the authors' words — written to be readable without the field's vocabulary, from the stored copy of the paper and nothing else. Drafted with xai:grok-4.5 and checked by a person. The authors' own sentences are the quotes below.

David Spiegelhalter did not write this page.

Every claim below was made in this piece, quoted word for word and numbered in the order the piece makes them, so you can read it there rather than take our word for it. The sentence above each quote is our reading of the claim, not their wording. Each quote was checked against a stored copy of the page at build time; where the two differ, the quote is the fact.

  1. Measurement of outcomes from medical or surgical interventions is part of good practice, but publication of individual doctors' results remains controversial.
  2. The administration believes the performance of a surgeon cannot be separated from that of his or her institution as quality is highly dependent on institutional systems.
  3. Because of this casemix influence it would not be sensible to publish unadjusted mortality by surgeon.
  4. The use of a single risk adjusted number to summarise a surgeon's results runs the risk of lending a level of spurious credibility to an analysis that does not take into account the impact of influences that are not patient related.
  5. No conclusions can be drawn until a full review has taken place. This sort of data cannot contribute to patient choice.