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Disclosure of individual surgeon's performance rates during informed consent: ethical and epistemological considerations.
Ann Surg 2007; 245(4):507-13AnnS

Abstract

OBJECTIVE

The purpose of the paper is to examine the ethical arguments for and against disclosing surgeon-specific performance rates to patients during informed consent, and to examine the challenges that generating and using performance rates entail.

METHODS

Ethical, legal, and statistical theory is explored to approach the question of whether, when, and how surgeons should disclosure their personal performance rates to patients. The main ethical question addressed is what type of information surgeons owe their patients during informed consent. This question comprises 3 related, ethically relevant considerations that are explored in detail: 1) Does surgeon-specific performance information enhance patient decision-making? 2) Do patients want this type of information? 3) How do the potential benefits of disclosure balance against the risks?

RESULTS

Calculating individual performance measures requires tradeoffs and involves inherent uncertainty. There is a lack of evidence regarding whether patients want this information, whether it facilitates their decision-making for surgery, and how it is best communicated to them. Disclosure of personal performance rates during informed consent has the potential benefits of enhancing patient autonomy, improving patient decision-making, and improving quality of care. The major risks of disclosure include inaccurate and misleading performance rates, avoidance of high-risk cases, unjust damage to surgeon's reputations, and jeopardized patient trust.

CONCLUSION

At this time, we think that, for most conditions, surgical procedures, and outcomes, the accuracy of surgeon- and patient-specific performance rates is illusory, obviating the ethical obligation to communicate them as part of the informed consent process. Nonetheless, the surgical profession has the duty to develop information systems that allow for performance to be evaluated to a high degree of accuracy. In the meantime, patients should be informed of the quantity of procedures their surgeons have performed, providing an idea of the surgeon's experience and qualitative idea of potential risk.

Authors+Show Affiliations

Phoebe R. Berman Bioethics Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. iburger@jhsph.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17414595

Citation

Burger, Ingrid, et al. "Disclosure of Individual Surgeon's Performance Rates During Informed Consent: Ethical and Epistemological Considerations." Annals of Surgery, vol. 245, no. 4, 2007, pp. 507-13.
Burger I, Schill K, Goodman S. Disclosure of individual surgeon's performance rates during informed consent: ethical and epistemological considerations. Ann Surg. 2007;245(4):507-13.
Burger, I., Schill, K., & Goodman, S. (2007). Disclosure of individual surgeon's performance rates during informed consent: ethical and epistemological considerations. Annals of Surgery, 245(4), pp. 507-13.
Burger I, Schill K, Goodman S. Disclosure of Individual Surgeon's Performance Rates During Informed Consent: Ethical and Epistemological Considerations. Ann Surg. 2007;245(4):507-13. PubMed PMID: 17414595.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Disclosure of individual surgeon's performance rates during informed consent: ethical and epistemological considerations. AU - Burger,Ingrid, AU - Schill,Kathryn, AU - Goodman,Steven, PY - 2007/4/7/pubmed PY - 2007/5/30/medline PY - 2007/4/7/entrez SP - 507 EP - 13 JF - Annals of surgery JO - Ann. Surg. VL - 245 IS - 4 N2 - OBJECTIVE: The purpose of the paper is to examine the ethical arguments for and against disclosing surgeon-specific performance rates to patients during informed consent, and to examine the challenges that generating and using performance rates entail. METHODS: Ethical, legal, and statistical theory is explored to approach the question of whether, when, and how surgeons should disclosure their personal performance rates to patients. The main ethical question addressed is what type of information surgeons owe their patients during informed consent. This question comprises 3 related, ethically relevant considerations that are explored in detail: 1) Does surgeon-specific performance information enhance patient decision-making? 2) Do patients want this type of information? 3) How do the potential benefits of disclosure balance against the risks? RESULTS: Calculating individual performance measures requires tradeoffs and involves inherent uncertainty. There is a lack of evidence regarding whether patients want this information, whether it facilitates their decision-making for surgery, and how it is best communicated to them. Disclosure of personal performance rates during informed consent has the potential benefits of enhancing patient autonomy, improving patient decision-making, and improving quality of care. The major risks of disclosure include inaccurate and misleading performance rates, avoidance of high-risk cases, unjust damage to surgeon's reputations, and jeopardized patient trust. CONCLUSION: At this time, we think that, for most conditions, surgical procedures, and outcomes, the accuracy of surgeon- and patient-specific performance rates is illusory, obviating the ethical obligation to communicate them as part of the informed consent process. Nonetheless, the surgical profession has the duty to develop information systems that allow for performance to be evaluated to a high degree of accuracy. In the meantime, patients should be informed of the quantity of procedures their surgeons have performed, providing an idea of the surgeon's experience and qualitative idea of potential risk. SN - 0003-4932 UR - https://www.unboundmedicine.com/medline/citation/17414595/Disclosure_of_individual_surgeon's_performance_rates_during_informed_consent:_ethical_and_epistemological_considerations_ L2 - http://Insights.ovid.com/pubmed?pmid=17414595 DB - PRIME DP - Unbound Medicine ER -