Taxpayers support tremendous amounts of research and development (R&D) through organizations like the National Institutes of Health (NIH) and other government agencies that go into funding medical research. Yet, this information is not readily available publically—although it’s easily accessible to doctors, it’s often extremely difficult for patients to find. In fact, the answers patients are looking for might not even exist.
For example, how would you find the best hospital for your child to have open-heart surgery? Despite the fact that a lot of information exists about specific heart defects some children are born with, outcomes across institutions are often not compared. Consider buying a car—would you get one without looking at Consumer Report ratings, or comparing prices across different dealers?
We effectively buy health care without the freedom to do comparison-shopping because huge variation amongst doctors and hospitals does exist. This applies not only to results, but also to procedures. Not having this data means that patients cannot make informed choices.
Culture of secrecy
How are patients heard? It is time to create more comparative care to allow patients to choose good outcomes. The system as it stands now expects patients to do the heavy lifting—to look for the best surgeons and hospitals by interviewing doctors and health care facilities they’re considering.
In 2013, the National Health Service (NHS) in the U.K. published the world’s first comparison data on surgeons, including everything from how many operations they perform, their outcomes and mortality rates. The Canadian Institute for Health Information (CIHI) does comparison reports on hospitals across the country, and is working on doing these for individual surgeons, but there is pushback.
While some hospitals and physicians are in favour of these changes, others prefer keeping their performance information private. Some doctors want to know how they compare to their colleagues, but not necessarily release this information to the general public.
However, access to this data should not be insider information where physicians know who is performing well and who is not, while leaving patients in the dark. The health care system should be based on transparency.
However, as is the case in the U.S., the Canadian medical system is based on hierarchy and autonomy, which are not conducive to transparency. It may not be sufficient even for doctors to look at their own numbers to determine how they’re doing since you need comparative data to understand the quality of care you’re providing.
But if patients cannot access this information, how would health care quality truly improve? Your Health System, an interactive website launched by CIHI in September 2014, which provides hospital and regional comparisons across 15 performance standards, is a big step towards health care transparency in Canada.
Pressure to be perfect
Dr. Teodor Grantcharov, a general surgeon at St. Michael’s Hospital and associate professor at the University of Toronto, is dedicated to transparency. He is currently developing the world’s first operating room black box, which makes his patients confident because they think it’s unlikely he has anything to hide if he’s willing to be open about his mistakes.
In fact, Dr. Grantcharov maintains a database of his procedures and outcomes. He has done this since he started practicing and knows exactly how many of each surgical procedure he’s performed as well as the number of patients who suffered complications. He can look back on his performance and understand what went wrong and why.
Practicing like this raises tough questions for him, but as professionals, should doctors not reflect on their own performance before their patients do? Physicians cannot improve if they don’t understand why something went wrong.
There is anxiety and concern among patients as well as a tremendous desire for transparency. This is critical because the doctor-patient relationship is based first and foremost on trust.
Medical professionals like Dr. Grantcharov are changing a culture that expects physicians to be perfect, an ideal that begins prior to medical school. Doctors need perfect grades to get into med school and then into a residency program. On top of that, they are expected to never make mistakes or forget anything. Consequently, those expectations have had a tremendous impact on quality improvement and implementing safety initiatives.
The culture of medicine may not favour transparency, and may even feel threatened by it, but we owe it to our patients and ourselves to provide the best health care practices.