Jeremy Laurance: A misplaced sense of loyalty leads to errors being buried


The first question on the lips of any patient who learns that one in two operations by some surgeons ends in failure will be: how can I avoid them?

The answer is: with difficulty. Your local trust may publish death rates for different specialties but is unlikely to release them for individual surgical teams, even supposing they collect the data. Your best hope, if you have contacts in the hospital, is to get them to ask around. Anaesthetists always know which are the best surgeons. Yet this is information of the greatest possible importance to patients. Without it, ministers' sloganising about "patient choice" is meaningless.

Cardiac surgeons have published their death rates for 13 years. Not only has this given patients choice – it has also helped crank up performance. Death rates among cardiac surgeons have fallen 50 per cent in the last decade. There is nothing like peer rivalry to produce peak results.

It is time other specialists followed the cardiac surgeons' example. Death is a useful criterion because it is easy to measure and indisputably a bad result. But it is too crude for operations for non life-threatening conditions. Other measures must be found and today's study by Imperial College is a step on that way.

Progress, however, is agonisingly slow. There are mutterings about a "club culture" that is prepared to cover up failings out of a misplaced sense of collegiality.

It won't do. Society will not stand for it. Doctors can no longer bury their mistakes and get away with it. The medical royal colleges, and ultimately ministers, must bang heads together and ensure specialists shape up.