One of the most important decisions a person can make is which doctor to trust with his or her medical care. A recent blog post[1] on our website discusses factors to consider when selecting your doctor, including the number of times a doctor has performed the specific operation you will undergo. If you are planning on open heart surgery, for example, it would be important to know how many times a doctor has performed that operation. In fact, the number of times a doctor has performed a specific procedure is one of the most predictive factors in determining the success rate of future medical care.[2] Patients, however, should not limit their analysis to just the total number of times a doctor has performed a specific operation. A much more predictive metric is the number of times a doctor has performed a specific operation at a given healthcare facility.
As with all things, context matters — particularly in a complicated area such as healthcare where teamwork is vitally important. In cardiac surgery, for example, a successful patient outcome depends not only on the individual surgeon, but the varied contributions of many healthcare providers such as anesthetists, intensive care specialists, intensive care nursing, ward nursing, junior medical staff, and so on.[3]
In the May 9, 2018 episode of Malcolm Gladwell’s excellent podcast Revisionist History, Gladwell discusses the effect of context on individual performance.[4] In the podcast, Gladwell highlights the landmark 2006 study by Harvard Business School Professors Robert S. Huckman and Gary P. Pisano, The Firm Specificity of Individual Performance: Evidence from Cardiac Surgery.[5] Surgeons often have privileges at different hospitals and facilities, meaning a given surgeon may perform the same operation at several different hospitals. Using patient mortality as the metric, Huckman and Pisano found that the quality of a cardiac surgeon’s healthcare at given hospital improves significantly with increases in his procedure volume at that hospital, but does not improve significantly with increases in the same procedure at other hospitals.
Huckman and Pisano demonstrate that increases in procedure volume for a surgeon at a given healthcare facility lead to a decrease in patient mortality at that facility. However, the same surgeon doing the same procedure at a different healthcare facility may be just as deadly at operation number 1 as they are on operation number 1,000 at that facility. Mere procedure volume is not predictive.
Huckman and Pisano’s findings are not entirely surprising because a surgeon is but one part of a team of doctors providing healthcare to a patient. Like any person, a surgeon has strengths and weaknesses. The team of doctors at a specific hospital may have worked together in the past with knowledge of their strengths and weaknesses with established routines to maximize strengths and minimize weaknesses. In essence, the skill, expertise, and success rate of healthcare is team specific.
As a result, a vital factor to consider when selecting a doctor is the healthcare facility and team where the operation will be performed. Without breaking down procedure volume to the level of a given healthcare facility, the statistic loses its predictive value. Such a general number fails to account for the fundamental importance of a healthcare team and facility in successful patient outcomes. As part of that, one should consider the number of specific procedures a doctor has performed at a given facility.
[1] https://frithlawfirm.com/blog/medical/medical-errors/find-good-doctor-virginia/.
[2] E.L. Hannan, J.F. O’Donnell, H. Kilburn, Jr., H.R. Bernard & A. Yazici, Investigation of the Relationship Between Volume and Mortality for Surgical Procedures Performed in New York State Hospitals, Am. Med. Assoc. (1989), available at https://www.ncbi.nlm.nih.gov/pubmed/2491412.; E. Hannan, H. Kilburn, H. Bernard, J. O’Donnell, G. Lukacik & E. Shields, Coronary Artery Bypass Graft Surgery: The Relationship Between Inhospital Morality Rate and Surgical Volume After Controlling for Clinical Risk Factors, 29 Med Care 1094–107 (Nov. 1991), available at https://www.ncbi.nlm.nih.gov/pubmed/1943270.
[3] A. Merry, W. Brookbank, Merry and McCall Smith’s Errors, Medicine and the Law 366 (Cambridge University Press, 2017).
[4] Available at https://itunes.apple.com/us/podcast/revisionist-history/id1119389968?mt=2&ign-mpt=uo%3D4.
[5] http://www.people.hbs.edu/rhuckman/firm_specificity.pdf.