Leading article: It is time to kick away the pedestal

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A new report from the Society for Cardiothoracic Surgery suggests that surgeons are still burying their mistakes. The authors argue that surgeons have resisted the introduction of measures to detect substandard practice among their colleagues through a "misplaced sense of collegiality" and that the lives of patients are being endangered as a result.

This is depressingly familiar. The 2001 inquiry into Bristol Royal Infirmary concluded that surgeons had closed ranks to protect their own colleagues in the mid-1990s when a large number of children undergoing open heart surgery at the hospital died. It would seem that not a great deal has changed over the past decade.

So what is the way forward? The Government argues that greater transparency – making more data available on the performance of individual surgeons – is the solution. This is sensible. Since the 2001 Bristol inquiry, the death rates for individual surgeons have been published and a traffic light system set up to highlight those with a high patient death rate. According to the report, there has been a 50 per cent improvement in the overall risk-adjusted death rate for cardiac surgery. As Professor David Taggart, president of the Society of Cardiothoracic Surgery, argues "noting stimulates change like clear comparable and publicly accessible evidence".

The criticism of the publication of death rates is that it might deter surgeons from taking on riskier patients. But as the report points out, there is no systematic evidence of patients being discriminated against in this way. Indeed, the fact that the average age of patients undergoing surgery has risen indicates the opposite.

Yet while greater transparency is a good idea, it is not sufficient to solve the problem of surgeons closing ranks and resisting change. There also needs to be a shift in social attitudes towards the medical profession. Surgeons need to be taken off their pedestal by NHS managers, politicians and the general public.

They need to be challenged and held accountable, rather than endlessly deferred to. Surgeons need to be treated as professional, but not infallible.

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