The value of surgeon-specific outcome data: results of a questionnaire.

OBJECTIVES: The publication of surgeon-specific data has been controversial. To assess the profession's opinion, a forum was organized at the 2015 EACTS meeting followed by a questionnaire of the value of surgeon-specific outcome and its impact. METHODS: A series of presentations were made including assessments of quality and safety in one major European country, the relationship between volume and outcome, the role of guidelines, the effect of publication of results on training, and discussion for and against publication of surgeon-specific data. A questionnaire was given to all attendees at the forum on the value of surgeon-specific data and their impact on the specialty. RESULTS: The questionnaire was completed by 118 attendees. Of the total, 69% felt that mortality is a surrogate for quality and that it should be reported at the hospital and unit level as opposed to the individual surgeon level, but 81% wished there were different criteria for quality outcome. Of the total, 91% felt that the individual surgeons' data should be collected but not published in public portals, and that publication produces risk-averse behaviour; 65% felt that it hinders innovation; 86% felt that EuroSCORE II is not reliable in identifying high-risk patients and the same number felt that it has affected entry into the specialty. CONCLUSIONS: The information that is collectable will be published, but we can control the way in which it is published and presented.

Documenting the process of patient decision making: a review of the development of the law on consent.

The doctor's role involves helping patients to understand their condition, including the anticipated benefits and risks of proposed treatments or omissions to treat. In order to treat, doctors require consent from patients but the duty to advise is equally strong if conservative management is appropriate. The recent judgement in the case of Montgomery has set a precedent for patient autonomy. However, doctors are still required to judge what risks they should disclose in their reasonable assessment of that patient and their specific situation. The General Medical Council reflects a consensus that the empowered autonomous patient is more likely to be satisfied with their clinical outcome than the passive victim of medical paternalism. Doctors, regardless of specialty, must counsel their patients adequately, paying particular attention to identifying material risks that are likely to be significant to their case.

What are the lessons of recent obstetric legal cases?

In this chapter, I review the ways in which the courts have handled a number of obstetric cases that have been brought to trial in the last 5 years, and compare the ways in which cases were approached previously. The aim is to draw lessons for the benefit of lawyers, patients, doctors, midwives, expert witnesses, and hospital managers. The increasing complexity of modern obstetric patients, the rising expectations of society, the shortage of experienced staff on labour wards, and unrealistic expectations of some experts all make it difficult for the courts to handle these cases.

The legal framework for end-of-life decisions in the UK.

We have reviewed the current UK guidance regarding withholding and withdrawing life-prolonging treatment in the infant and termination of pregnancy for fetal malformation. We provide summaries of the key cases. The framework provided by professional bodies and the law in this difficult area stresses the importance of good and frequent communication between different professional groups and parents with early recourse to second opinions if a difference of view emerges. Legal proceedings should be used only as a last resort.