FREEDOM OF MEDICAL INFORMATION COMING -- SLOWLY

In Britain

Heart surgeons are to be forced to publish data showing how many of their patients have died, despite fears that such figures can be misleading. All heart units in the country have been told to send in the data, naming individual surgeons and showing how successful they are.

The Government promised in 2002 to make such data public by April this year. The target was missed after the Society of Cardiothoracic Surgeons - which has pioneered such measurements in Britain - said that it did not have enough data to make meaningful comparisons between individual surgeons that took account of the difficulty of the cases they undertook. Instead, in September the society published mortality data for one operation - heart bypass surgery - that did not name the individual surgeons. All 220 surgeons listed anonymously fell within the agreed standards: nobody failed.

Health Service Journal reports this week that the Department of Health has lost patience with the society and taken the decision to force publication on the reluctant surgeons. The society's database, set up in 1996, is to be merged with the department's own central cardiac database. This will enable more meaningful information to be released to the public, Roger Boyle, the National Director for Heart Disease, said. "It will give us long-term outcomes, mortality data and measures for other procedures such as angioplasty and, hopefully, quality of life," he said.

Sir Bruce Keogh, president-elect of the society and Professor of Surgery at University College London, started the society's database in 1996, long before there was any government interest in the subject. What started as a 12-page document now runs to 352 pages, which Sir Bruce has produced with no help from the Government. "Every single word has been typed by me in my annual leave," he said.

He said that the April target had been missed because the data collection facilities promised by the Government and needed to make fair comparisons between surgeons were not in place. The timescale had been overambitious and changes made by the department that shifted decision-making to trusts meant that ministers or officials could no longer order hospitals to gather the data.

Sir Bruce denied that the surgeons had cold feet. "No one is shying away from having a discussion about their own results," he said. "They are shying away from results being presented in such a way that's going to see them crucified because they take on cases that are high-risk or difficult. We were worried that as surgeons that if we didn't publish something people would say: "There you go; they have reneged.' We had to do something to show we were doing our best."

The worry is that data not "stratified by risk" will mean that surgeons who operate on older or iller patients will come out looking bad. Patients could suffer because unless they are straightforward cases they could find it hard to get a surgeon to operate. In Pennsylvania, where risk-stratified data has been published since 1992, a survey showed that this is what had happened. Among cardiologists, 59 per cent said that it was harder to find a surgeon to do bypass operations on severely ill patients.

Ministers pressing for data on named surgeons to be published may still face delays. Sir Bruce said that even when the system was in place, it would be three years before enough information had been collected.

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