Mr Jules Dussek
The shock-wave of the GMC enquiry
into paediatric cardiac surgery at Bristol
is spreading not only through cardiothoracic surgery but the whole of medicine
in the United Kingdom. So far there have been two television programmes
devoted to the subject and at the time of writing I know of two other
non-complimentary programmes being made about other consultants in our
specialty. It will no longer be possible for doctors to be secretive
about their results, the public and the department of health want to know
them. David Wheatley and
the Standards of Care Committee
had already done a great deal of work on this subject with the result
that before the Bristol
verdict and subsequent outcry a mechanism had been established to
monitor certain marker operations
for each of the subspecialties ofcardiothoracic surgery. We were already in
the forefront of any other specialty in data collection and this venture is again far ahead of any
other branch of medicine or surgery but it has caused considerable and
understandable anguish to our members and many have written to me on
the subject.
Possibly the biggest single anxiety is the lack of a requirement for
some form of Risk Stratification. The problem is that there are still
units who are unable to provide an accurate Parsonnet score and if we
ask for something that is not available we will not even get the basic
data that we require. Obviously it is in everyone's interest to ensure
that their hospital supplies them with the wherewithal to collect the
appropriate data. The second problem concerns small numbers of a certain
procedure and the third relates to units or surgeons who think they are
doing the worst cases.
The analysis of the individual surgeons' data will be extremely sensitively
handled and we will be using the services of a highly reputable statistician
from outside the Society to look at the figures. What we will be looking
for are results that fall well outside what would be considered an
acceptable range. Perhaps we should consider the analogy of Formula One
car racing. All the drivers are exceptionally good drivers but
occasionally one stands out as dangerously slow, 'a mobile chicane'.
He is obvious and the other drivers want him banned before he causes
an accident. The cause is sometimes remediable sometimes not, but in the rest of the pack there will be drivers who one week may lead the race and another time be at the back but they are still all first class drivers. We are simply trying to spot a mobile chicane before there is an accident.
As President I have to admit to having the same anxieties as the rest
of the membership. Am I going to become more selective about the
patients I offer a lobectomy to? Will I do wedge excisions on patients
I think are of above average risk? Like nearly every other member I
think I get all the worst cases! This system of performance assessment
may appear imperfect but it is in its first year and we have no other
specialty to gain experience from. The most important factor is that
confidentiality of individual results must be preserved at all costs
and the members must have confidence in the fairness with which the
system is run.
Do not despair. I recently met Sir Donald Irvine and Sir Kenneth Calman
at a meeting set up by David Wheatley and the loud message was that
they were thoroughly aware of the fact that the cardiothoracic surgeons
were in the vanguard of surgical specialties and that overall the
quality of our practice and data collection
was exemplary.
