Informed Consent and Clinician Accountability: The Ethics of Report Cards on Surgeon Performance

by Edited by Steve Clarke , Justin Oakley

• ISBN13: 9780521687782
• ISBN10: 0521687780
• Edition: 1st
• Format: Paperback
• Copyright: 2007-08-13
• Publisher: Cambridge University Press

Summary

This timely book analyses and evaluates ethical and social implications of recent developments in reporting surgeon performance. It contains chapters by leading international specialists in philosophy, bioethics, epidemiology, medical administration, surgery, and law, demonstrating the diversity and complexity of debates about this topic, raising considerations of patient autonomy, accountability, justice, and the quality and safety of medical services. Performance information on individual cardiac surgeons has been publicly available in parts of the US for over a decade. Survival rates for individual cardiac surgeons in the UK have recently been released to the public. This trend is being driven by various factors, including concerns about accountability, patients' rights, quality and safety of medical care, and the need to avoid scandals in medical care. This trend is likely to extend to other countries, to other clinicians, and to professions beyond health care, making this text an essential addition to the literature available.

Table of Contents

List of contributors	p. viii
Acknowledgements	p. xi
Introduction: Accountability, informed consent and clinician performance information	p. 1
Accountability	p. 23
Part introduction	p. 25
Clinician report cards and the limits of evidence-based patient choice	p. 27
Report cards for institutions, not individuals	p. 41
Safety, accountability, and 'choice' after the Bristol Inquiry	p. 52
Public reports: putting patients in the picture requires a new relationship between doctors and patients	p. 65
Adverse event disclosure: benefits and drawbacks for patients and clinicians	p. 76
Report cards and performance monitoring	p. 91
Informed consent	p. 107
Part introduction	p. 109
Informed consent and surgeons' performance	p. 111
The value and practical limits of informed consent	p. 134
Against the informed consent argument for surgeon report cards	p. 147
Trust and the limits of knowledge	p. 157
Surgeons' report cards, heuristics, biases and informed consent	p. 167
Report cards, informed consent and market forces	p. 180
Reporting performance information	p. 193
Part introduction	p. 195
Is the reporting of an individual surgeon's clinical performance doing more harm than good for patient care?	p. 197
Examining the link between publicly reporting healthcare quality and quality improvement	p. 212
Hospital and clinician performance data: what it can and cannot tell us	p. 226
An ethical analysis of the defensive surgery objection to individual surgeon report cards	p. 243
Surgeon report cards and the concept of defensive medicine	p. 255
Training, innovation and surgeons' report cards	p. 266
Doctors' report cards: a legal perspective	p. 279
Index	p. 294
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