Friday, March 25, 2011


Here’s a study result that’s presented as reassuring but actually should provoke more thought:
This month The Journal of the American College of Surgeons published the results of a study on how well patients come through when a surgeon-in-training is involved in the operation. Analyzing the results of more than 600,000 operations at more than 225 hospitals across the country, researchers found that while resident involvement was indeed associated with slightly higher complication rates and longer operating times, those patients who had trainees participating in their operations also experienced decreased mortality rates.

That data revealed that while patients who had residents participating in surgery did develop more complications, those complications were not necessarily serious. And once one complication occurred, those patients with residents involved in their care were more likely to recover and less likely to fall prey to the so-called domino effect of complications, where one leads to another and ultimately to death. “It may be the fact of having a whole team of surgeons rather than just one that ‘rescues’ patients from these complications and even death,” Dr. Ko observed.

For example, for every 1,000 people who underwent colon surgery with trainees present, 30 patients experienced complications who wouldn’t have if they had undergone the same operation without residents. But five patients who would have died ended up surviving because trainees were involved in their surgery and care. “The question might then become,” Dr. Raval added, “‘Would you accept the risk of a urinary tract infection that required an antibiotic for several days if you knew it might save your life?’”

The blog post that I’ve taken this from posits this as a reason for optimism—that is, don’t be worried you’ve got an internist operating on you! And being less likely to die is an excellent reason to not be worried, right?

But there’s a followup-question that’s worth asking: well, if that’s true, then why? Why is it experienced doctors get better at one important measure while getting worse? Does this say a lot for the medical profession that introducing a novice to help apparently improves performance in at least one critical field? What is it we can learn from the study to decrease the number of complications and deaths in operations not blessed with an internist?

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