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JLeslie's avatar

Did you know this about your surgeons death rate statistics?

Asked by JLeslie (59783points) December 11th, 2016 from iPhone

Not just surgeons, but in general about hospital care. The surgery goes bad, or your relative will likely die within hours or days, and they will want the patient transferred to hospice to get that death stat on hospice and not the surgeon or the general hospital statistics. Often, it’s in papers that you the deciding relative have to sign off on in your moment of despair regarding your loved one who is suddenly dying, and you can choose not to sign it. I say suddenly, because in my opinion it’s totally different if someone has been terminal for a while, or very very old, and in the final weeks or months of life they utilize hospice.

I think hospice care is a great service, and this is not a comment about hospice at all. This is mostly a comment about how a surgeon or hospital can alter survival rates of various medical events

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34 Answers

chyna's avatar

Can you site your source?

johnpowell's avatar

I’m calling BS without a legit source.

JLeslie's avatar

It’s a very close relative who has to get people to sign that document and hates doing it.

Whether you agree or not on this Q, it’s something to know in the back of your head in case you’re ever in the situation. If you never use the information then that’s a good thing. If somehow you prove me wrong in the future I’m not hurt by that. If you find out I’m right the hard way at least you will be armed with more info.

elbanditoroso's avatar

No, I don’t. And I don’t think it is a valid figure, anyway.

Numbers without explanation or context are not meaningful. A pediatrician is likely going to have a much lower death rate than a physician who works with the elderly.

In addition, there any of reasons why an elderly person could die, that literally have nothing to do with the doctor or the hospital. A person could have the best medical care in the world and still expire.

Sorry, @JLeslie – even if there is proof of this allegation, it’s a very shaky thing to use to assess your doctor or your hospital.

johnpowell's avatar

I speak regularly to three doctors and they have a lot to say about the problems in the system but this isn’t one of those things.

I don’t doubt that it does happen. I just don’t think it is widespread. This actually says more about your relative than the medical profession as a whole.

JLeslie's avatar

@elbanditoroso I would never compare geriatric to pediatrician. If you’re dealing with a pediatric doctor, you want to know his stats in particular for whatever particular surgery being done.

JLeslie's avatar

@johnpowell Are they surgeons who do risky surgeries?

johnpowell's avatar

No.

But one frequently has to inform the family that someone died.

So you are saying you have a relative that is a surgeon and does that? Have you considered reporting them to the AMA? By not reporting them you could be culpable in their death.

JLeslie's avatar

My relative is not a surgeon, she is administrative, and it’s part of the hospital paperwork. She doesn’t make any decisions really regarding the patients care.

Edit: There’s nothing wrong with the patient care. A patient who is dying receives good care in hospice.

johnpowell's avatar

But if they think that care is wrong it is their duty to report it.

JLeslie's avatar

^^See my edit above. The care is good care. This is about stats.

johnpowell's avatar

So it is just fraud. Gotcha.

JLeslie's avatar

I’m not sure if it’s technically fraud really, it’s just manipulative a little. I’m not saying everyone who they send to hospice is part of manipulating a stat, I’m just saying it happens. I’m sure it’s different in different hospitals too.

johnpowell's avatar

I mean you said the surgeon did all they could. Maybe that is it. The person will die so free up the bed for people that can be actually saved.

This is like Facebook fake news shit. I heard some shit rag runs with it and people listen and now it is truth…

zenvelo's avatar

This stuff is done more by hospitals than doctors. Your administrative relative is doing it for her bosses, not for the doctors.

Rarebear's avatar

The human population death rate is 100%.

Espiritus_Corvus's avatar

Yeah, Leslie. The whole damn medical establishment has been out to get you for years now. It’s personal.

JLeslie's avatar

@zenvelo That might be the case.

@Espiritus_Corvus No need for sarcasm. People can make their own evaluation if the moment arises for them. I know very few people who work in the medical system like you who think everyone is so wonderful in it. I know there are very hard working, caring, talented medical professionals in our country, but there’s a lot of crap that happens too. Both because of shitty care, and because of the shitty system. If you think what I stated doesn’t happen you can state right in this Q as a medical professional. It looks like most of the jellies here will believe you. They lean that way anyway.

@johnpowell The surgeon did all he could, but you want to know if his death rate is 70% and the other doctor in town is 30%. I’m using extreme numbers just as an example totally made up. You don’t think all surgeons are equal do you?

It’s like fertility clinics. Some boast stats of pregnancies. There are books published for these stats. Then some people will say that stat means nothing, you want stats of actual births. Then, there are fertility clinics who take very hard cases that have great doctors, and their stats are low, because they are willing to take difficult cases. The stats need questioning.

Seek's avatar

When I needed a surgery, it was because my gallbladder was inflamed, full of stones, and causing me extreme pain. It was also the middle of December, and over 20 different surgeons’ offices simply told me they didn’t feel like working until after the holidays.

The beggars’ power of choice prevented me from caring much about pointless statistics that may or may not be administrative voodoo.

chyna's avatar

Let me see if I have this straight. You have a relative that is not medically trained because they are working in an administrative role. Based on this persons observations, in a non medical way, this person has come up with some kind of statistics that merely serve to feed your extreme dislike of doctors. I work with doctors too. Just because one doesn’t wash her hands, ever, doesn’t mean they all are assholes.

JLeslie's avatar

@chyna Nurse. BS in nursing, RN. Previously, worked giving medical treatment hands on as a nurse. Now he does administrative stuff.

Where did I say all are assholes? I said just up above there are many good caring doctors.

Espiritus_Corvus's avatar

My sarcasm was due to a lot of the questions you’ve asked over the years, some of which were just paranoid in my book. Sorry about that. But, actually, this question is legitimate and I’ve addressed the deterioration of patient care on this site many, many times.

No, I don’t deny that since privatization, statistics are purposely skewed. It has to do with hospital competition that has arisen since privatization. Since MBAs have taken charge of running hospitals, instead of professionals with strong medical backgrounds, the focus has drifted from the patient to the bottom line. America was scammed into trading off their community hospitals for for-profit hospitals and now you see the results.

This is the main reason I retired from nursing.

The focus was no longer on the patient. We never made a decision pertaining to the level of care a patient was to receive based upon the quality of their insurance when I began as a nurse. That was unheard of and would have been considered highly unethical. A patient received the highest level of care available based on their diagnosis. This is no longer true. Times changed and I wouldn’t, so like many nurses from my era, I left.

You people are getting fucked royally with inferior care at a much higher cost. When they privatized, they added another entity that must get paid—the shareholders and investors—and this has significantly driven costs sky high.

Most of the problems of hospital care come due to understaffing, and hospitals understaff now like never before. Labor is expensive. Skilled labor even more so. They must keep the labor costs down to insure the shareholders get paid. Also, younger and inexperienced staff is cheaper than older, experienced staff.

Here’s some stat-skewing for ya: In the last years of my career, I would do a shift on a PCU or an ER to keep my skills up. More often than not, I would take report at the beginning of shift on one floor, then be notified that I was to be transferred to another where I had to take report and sign off again. Sometimes this would happen three times at the start of my shift. This may have happened once or twice in my early years, but it had become SOP by the early 2000’s.

And this is why I, and many other nurses’ shifts begin this way:

Most hospitals, for-profit and not for-profit, receive a minimum of 25% of their annual budget in federal funds with certain strings attached. One of those strings is that every patient must be guaranteed a certain level of care. So, there is a system of compliance and federal monitoring that is supposed to provide that.

This is the system: Every patient is assessed when they are admitted to the hospital and given so many Acuity Points depending on the seriousness of their diagnoses. The amount of all the acuity points added up over a 24 hour period determines the amount of staff the hospital must have on board in order to be in compliance. This can get quite expensive and hospital administrators have found a way to cook the books.

I would take and sign off report on one floor, then be re-assigned to another, then sometimes re-assigned yet again. I didn’t know it at the time, but I was being counted in the computer as three nurses on board that shift. This is how the hospitals would keep in federal compliance. Multiply that by many nurses being re-assigned every shift and you have compliance, short-staffing and patients put at risk. Complaints by staff will only get those individuals replaced.

So, there ya go. I agree with you. You’re getting fucked.

JLeslie's avatar

^^The nurses are often fucked. They are overstretched in how many patients they cover all too often. Most nurses do care about doing their jobs well (I think most people do) and especially in ER’s, ICU, and other units that’s have acute cases I think sometimes the stress level in them when they are assigned too many patients is really bad, and can affect patient care, but it affects the nurses too.

I worked for a behavioral hospital and bottom line was very important and it was part of a group of hospitals owned by a corporation. There was a tight line walked between the people in charge caring about patient care and watching the bottom line. We definitely had times where I, and other felt there were not enough nurses staffed. Overall, the employees from counselor, nurses, and doctors really liked working in psych and cared about the patients.

I saw doctors reverse orders to release a patient, even when it meant the hospital would make zero dollars for the additional days the patient would be staying. This was in more extreme cases obviously, where a patient really was not with reality.

I know why you were sarcastic, it’s no secret I’m fairly negative about health care and my expectations are quite tarnished. I also have talked about good experiences with my healthcare. Those are fewer admittedly, but I understand they go unnoticed, because I have so much negativity. None of my negative experiences or bad care are lies though. They are either humans make mistakes, medicine doesn’t know the answer, insurance and legal problems interfere with patient care, or incompetence. Meaning at any given time my dissatisfaction is likely one of those four things.

canidmajor's avatar

@JLeslie, do you live in a place, and with such outstanding insurance/wealth that you have so much choice about medical caregivers/hospitals? For most of us, location and finances limit our choices. That is not a statistic that ever occurs to me to check.
I’m sure you would consider me na├»ve, but I generally go into medical circumstances with an open mind and a faith that things will go well. In a younger day I had reason to question the judgement (never the actual medical competence) of the physicians I consulted, so I don’t say the above because of a lack of experience.

With this particular issue, I think you are reaching. It may happen, but so what? This obsession you have with all things medical may be a good hobby for you to spend your time on, but I, personally, am grateful that I can get pretty decent care (I’m still walking around, after all) when I need it. I prefer to devote the rest of my time to other, more productive, more interesting pursuits.

jca's avatar

I wouldn’t doubt it. I don’t know a lot of people that have surgeries but I don’t doubt that someone that works in hospital administration and sees large numbers of surgical patients is aware of tricks that are done to alter statistics. I’ve also heard of hospitals with very sick patients who want the patient sent home or elsewhere so the statistic (and resulting paperwork) is not with them that the patient died there. Patients with no insurance who have not taken care of themselves and may very well continue to not take care of themselves and are very ill, the hospital wants them out and refers them to follow up care, knowing it’s likely the person is not going to be able to access that care with their bad or no insurance.

There are also some types of doctors that are just going to have a higher rate of death for their patients than others. Surgeons and anesthesiologists, for example, will have a higher death rate than a dermatologist.

JLeslie's avatar

@canidmajor I remember when my dad needed bypass surgery. He usually had his healthcare done at Bethesda Naval hospital. At the time he needed his surgery, the cardiology department was under investigation and no surgeries were being done. The military sent him to one of the top surgeons in the area. Top, I would assume, means good outcomes. It was over an hour drive from my parents’ home to the hospital that surgeon was credentialed at. There were many many hospitals and surgeons in-between.

When my friend’s dad decided on surgery for his prostate cancer, yes he researched doctors and outcomes.

Like @Seek said, in an emergency you don’t have much choice. When my husband had his gall bladder attack he just used the surgeon assigned to him by the hospital. He had come in through the ER, it was his third attack, and he was home in America this time. He didn’t want to go back to Colombia and need emergency surgery there, so he did the surgery rather on the spot in America. My husband is more trusting of doctors also though. Although, that is changing a little as he ages. He’s still better than me at dealing with medical people, I am more in edge than the average person no question. I say it all the time. I’m also, as my therapist said, often right. It just makes it worse. I know a shitload more than my husband about medicine, so he doesn’t even know when they are screwing up. Most people don’t know. I don’t claim to know as much as doctors or other medical professionals, I never have. Obviously, the education and experience means something.

Espiritus_Corvus's avatar

Edit: It’s been awhile so I had to check. Acuity Points are totaled every eight hours, not every twenty-four, and this determines the amount of staff that must be on board in order for a hospital to be in federal compliance.

JLeslie's avatar

@canidmajor I’ll add that most of America is middle or upper class with insurance, so if we make it a given that you are not in an emergency situation, you do have time to research, or get a second opinion. I completely agree the lower income effects how choosy one can be about medical care or even seeking it in the first place.

Hell, I can afford medical care, but I hate throwing money away when seeing a doctor gets me nothing, so I often avoid going. Right now I really really need to see four doctors. I’m way overdue for a colonoscopy (I’ve had polyps since my early 30’s, and colon cancer in my family), I’m overdue for a Pap smear and I’m having a GYN problem that needs medication, and I have three things that I need removed from my skin (one suspicious in my opinion) and I haven’t had an all over deem check in 5 years, and I very badly need to see my endocrinologist. I’m waiting until 2017 when my deductible starts over again.

canidmajor's avatar

So yes you have money, great insurance, and lots of medical care choices. Congratulations.
I have a $6000 deductible, a limited list of providers to choose from, and, frankly, having had cancer with good coverage, I am aware of how much out-of-pocket incidental stuff one has to pay.
Like I said, this seems to be a hobby you are devoted to, enjoy it. I prefer cooking and gardening and other stuff.

LuckyGuy's avatar

@JLeslie I get where your coming from. When I was shopping for a surgeon to remove my prostate (in 2009) I found it was incredibly difficult to find any meaningful, publicly available metric to help me with my decision.
I could get easily get 2000 unbiased, specific reviews of a hammer or 15,000 reviews of a digital camera on Amazon but could find nothing similar for my situation.
I did find one statistic about post prostatectomy rates of incontinence but then discovered different surgeons had different definitions of continence! Some considered LFPF, Leak free pad free, as continent while others considered one pad per day as continent. One (sleazy) surgeon considered 2 pads per day as continent and used the word “controlled”.
Maybe there is an Angie’s list for surgeons now? If not, there should be.

My final recommendation came from asking a trusted OR nurse what she saw and her suggestion. She was absolutely correct.

kritiper's avatar

Hospitals don’t want to advertise their death rates because people might stop going there for treatment. (So says the 2013 episode of “Frontline: Hunting the Nightmare Bacteria.” a copy of which was found at the local library on DVD.)

Espiritus_Corvus's avatar

Another way the US public is getting screwed is the widespread implementation of DRGs that came in with the privatization of community hospitals. If you read the definition of DRGs in the link, they look very benign and sensible. But notice the emphasis on the financial end and the subtle drift from the of level of patient care based on individual cases and toward patient care based on the average national survivability rate of patient’s diagnoses. In reality, the practical implementation of DRGs are the definition of corporate insidiousness.

Nurses saw the danger of implementing DRGs almost immediately. DRGs were used to justify shortening hospital stays often without any regard to the nuances of an individual patient’s needs.

Just after nursing school and after the standard year on a med-surge floor, I specialized in cardiac patients because I’m no genius and I found the heart an interesting and easy mechanism to understand. It is basically a chemical battery operated, four-chambered pump. There is muscular chemistry and muscular neurology involved, but cardiology is much less complicated than general neurology and all the complicated, interrelated chemistry involved in internal medicine. So, I quickly found a home and there was no shortage of patients.

When I began my career, a CABG (Coronary Artery Bi-pass Graft) patient would be sent from the OR, to the ICU for a day or less, to ensure stabilization, then to a PCU or med-surge floor for post-op recovery. Usually they would spend about seven days to ten days in the hospital post-op altogether if there were no complications. During this time, they would be wired with 12-lead and then 3-lead EKG wi-fi’d directly to individual monitors at the nursing station which were watched 24/7 by an EKG tech. We would get them walking, teach them all about their condition and what they needed to know to live a healthy life as a post CABG patient, and finally pull the EKG leads, pull the staples out of their chest and send them home.

With the implementation of DRGs, the average stay for a CABG patient was cut to three days. In the beginning, the patients were sent home and a home health group, provided by the hospital as standard care, would be contracted to send a nurse to visit them, monitor for infection, supervise the administration of meds, get the patient walking, pull the staples and report to the doctor on patient condition after every visit. Unless there had been dangerous cardiac dysrhythmias in the hospital, the patient was sent home without a halter monitor. Nursing staff was appalled.

Soon thereafter, lobbying efforts by that portion of the healthcare industry that owned hospitals had the standards changed so that standard care for these patients no longer involved home health services. Unless the patient’s private insurance paid for it, none was provided. Many nurses began to check on their former patients at home on their own time because we began hearing of deaths due to infection and cardiac arrests. (Statistically, these fatalities were off the hospital books.) Also, we saw many of these patients returned to us through the ER in very bad shape.

Nothing takes the wind out of a nurse’s sails more than hearing that their patient experienced unnecessary complications or didn’t make it—especially when the cause of death is easily preventable.

DRG’s were the worst thing ever implemented in public health, as far as I am concerned.

JLeslie's avatar

@canidmajor I’m not sure I understand your disgust. I pay $800 a month for insurance for my husband and me and I think our deductible is $3500. It’s a ton of money. I’m not competing with you, I’m just laying out my situation.

I don’t go looking for medical things to be annoyed with, it’s just when I hear about them, or deal with something medical myself it stays with me, for other people it goes over their head, or rolls off their back.

It’s not a hobby, it’s just another thing. I don’t think about it day and night, and I certainly don’t hunt for more examples of where the medical field lets me down. I don’t need to hunt for any such thing, it falls in my lap.

I probably should hunt – research – this stuff and start writing articles and my congressman.

And, even if it is a hobby, why are you bothered by it? Why are you telling me that? Yes, I’m interested in medical care, medical systems, medical discoveries, medical mistakes. So what? I’m also interested in travel, cooking, solar energy, and decorating.

canidmajor's avatar

You’re right, @JLeslie, expressing my annoyance is rude here and I apologize. We have different interests and I should not be denigrating yours.

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