{"id":2506,"date":"2014-12-15T08:47:23","date_gmt":"2014-12-14T21:47:23","guid":{"rendered":"http:\/\/blog.panicola.com\/?p=2506"},"modified":"2014-12-15T08:47:23","modified_gmt":"2014-12-14T21:47:23","slug":"amplio-surgeon-score-cards","status":"publish","type":"post","link":"https:\/\/blog.panicola.com\/?p=2506","title":{"rendered":"Amplio – surgeon score cards"},"content":{"rendered":"

https:\/\/medium.com\/backchannel\/should-surgeons-keep-score-8b3f890a7d4c<\/p>\n

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Making the Cut<\/h2>\n

<\/a>Which surgeon you get matters\u200a\u2014\u200aa lot. But how do we know who the good ones are?<\/em><\/h4>\n
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<\/a>\u201cYou can think of surgery as not really that different than golf.\u201d Peter Scardino is the chief of surgery at Memorial Sloan Kettering Cancer Center (MSK). He has performed more than 4,000 open radical prostatectomies. \u201cVery good athletes and intelligent people can be wildly different in their ability to drive or chip or putt. I think the same thing\u2019s true in the operating room.\u201d<\/p><\/blockquote>\n

<\/a>The difference is that golfers keep score. Andrew Vickers, a biostatistician at MSK, would hear cancer surgeons at the hospital having heated debates about, say, how often they took out a patient\u2019s whole kidney versus just a part of it. \u201cWait a minute,\u201d he remembers thinking. \u201cDon\u2019t you know <\/em>this?\u201d<\/p>\n

<\/a>\u201cHow come they didn\u2019t know this already?\u201d<\/p>\n

<\/a>In the summer of 2009, he and Scardino teamed up to begin work on a software project, called Amplio (from the Latin for \u201cto improve\u201d), to give surgeons detailed feedback about their performance. The program\u2014still in its early stages but already starting to be shared with other hospitals\u200a\u2014\u200astarted with a simple premise: the only way a surgeon is going to get better is if he knows where he stands.<\/p>\n

<\/a>Vickers likes to put it this way. His brother-in-law is a bond salesman, and you can ask him, How\u2019d you do last week?, and he\u2019ll tell you not just his own numbers, but the numbers for his whole group.<\/p>\n

<\/a>Why should it be any different when lives are in the balance?<\/p>\n

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Andrew Vickers<\/figcaption><\/figure>\n

<\/a>The central technique of Amplio<\/a>, using outcome data to determine which surgeons were more successful, and why, takes on a powerful taboo. Perhaps the longest-standing impediment to research into surgical outcomes\u200a\u2014\u200athe reason that surgeons, unlike bond salesmen (or pilots or athletes), are so much in the dark about their own performance\u200a\u2014\u200aare the surgeons themselves.<\/p>\n

<\/a>\u201cSurgeons basically deeply believe that if I\u2019m a well-trained surgeon, if I\u2019ve gone through a good residency program, a fellowship program, and I\u2019m board-certified, I can do an operation just as well as you can,\u201d Scardino says. \u201cAnd the difference between our results is really because I\u2019m willing to take on the challenging patients.\u201d<\/p>\n

<\/a>It is, maybe, a vestige of the old myth that anyone ordained to cut into healthy flesh is thereby made a minor god. It\u2019s the belief that there are no differences in skill, and that even if there were<\/em> differences, surgery is so complicated and multifaceted, and so much determined by the patient you happen to be operating on, that no one would ever be able to tell.<\/p>\n

<\/a>Vickers said to me that after several years of hearing this, he became so frustrated that he sat down with his ten\u00ad-year-\u00adold daughter and conducted a little experiment. He searched YouTube for \u201cradical prostatectomy\u201d and found two clips, one from a highly respected surgeon and one from a surgeon who was rumored to be less skilled. He showed his daughter a 15\u00adsecond clip of each and asked, \u201cWhich one is better?\u201d<\/p>\n

<\/a>\u201cThat one,\u201d she replied right away.<\/p>\n

<\/a>When Vickers asked her why, \u201cShe looked at me, like, can\u2019t you tell the difference?<\/em> You can just see.\u201d<\/p>\n

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