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11 - Surgeons' report cards, heuristics, biases and informed consent

Published online by Cambridge University Press:  08 August 2009

Steve Clarke
Affiliation:
Centre for Applied Philosophy and Public Ethics, Charles Sturt University and Program on the Ethics of the New Biosciences, James Martin 21st Century School, University of Oxford, UK
Steve Clarke
Affiliation:
University of Oxford and Charles Sturt University, New South Wales
Justin Oakley
Affiliation:
Monash University, Victoria
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Summary

Informed consent and surgeons' performance information

An important reason for providing patients with performance data on individual surgeons is to enable patients to make better decisions about surgery, as a part of the informed consent process. Surgeons' performance data can be utilized to enable a variety of types of decision that a patient may face. A patient can utilize performance data on individual surgeons to enable a choice between available surgeons. A patient can utilize surgeons' performance data when deciding between surgery involving an available surgeon and a non-surgical alternative form of treatment. Also, a patient can utilize surgeons' performance data to help decide whether or not to wait for a high-performing surgeon, who is not currently available, to become available.

Traditionally, performance data on individual surgeons have not been disclosed to patients, and such data have not usually been thought necessary to disclose for the purposes of providing effective informed consent. Canonical treatments of the doctrine of informed consent, such as Faden and Beauchamp (1986), do not consider the possibility of making such information available to patients. However, it has recently been argued that the doctrine of informed consent implicitly requires that surgeons' performance data be made available to patients (Clarke and Oakley, 2004). The gist of this argument is easy enough to grasp: it is uncontroversial that the significant and material risks associated with an operation should be disclosed to a patient who is contemplating that operation.

Type
Chapter
Information
Informed Consent and Clinician Accountability
The Ethics of Report Cards on Surgeon Performance
, pp. 167 - 179
Publisher: Cambridge University Press
Print publication year: 2007

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References

Beauchamp, T. L. and Childress, J. F. (2001). Principles of Biomedical Ethics, 5th edn. New York: Oxford University Press.Google Scholar
Clarke, S. (2001). Informed consent in medicine in comparison with consent in other areas of human activity. The Southern Journal of Philosophy, 39, 169–87.CrossRefGoogle Scholar
Clarke, S. and Oakley, J. (2004). Informed consent and surgeons' performance. The Journal of Medicine and Philosophy, 29, 11–35.CrossRefGoogle ScholarPubMed
Faden, R. R. and Beauchamp, T. L. (1986). A History and Theory of Informed Consent. New York: Oxford University Press.Google Scholar
Gigerenzer, G. and Todd, P. M. (1999). Fast and frugal heuristics: the adaptive toolbox. In Simple Heuristics that Make Us Smart, ed. Gigerenzer, G., Todd, P. M. and the ABC Research Group. New York: Oxford University Press, pp. 3–34.Google Scholar
Gilovich, T. and Griffin, D. (2002). Introduction – heuristics and biases: then and now. In Heuristics and Biases: the Psychology of Intuitive Judgement, ed. Gilovich, T., Griffin, D. and Kahneman, D.. Cambridge: Cambridge University Press, pp. 1–18.CrossRefGoogle Scholar
Gould, S. J. (1991). Bully for Brontosaurus: Reflections in Natural History. London: Penguin.Google Scholar
Healthcare Commission (2006). Press release: patients have access to rates of survival for heart surgery for the first time. http://www.healthcarecommission.org.uk/newsandevents/pressreleases.cfm?cit_id=3785&FAArea1=customWidgets.content_view_1&usecache=false.
Hibbard, J. H. (2003). Engaging health care consumers to improve the quality of care. Medical Care, 41, Supplement I.61–I.70.CrossRefGoogle ScholarPubMed
Hibbard, J. H., Slovic, P. and Jewett, J. J. (1997). Informing consumer decisions in health care: implications from decision-making research. The Millbank Quarterly, 75, 395–414.CrossRefGoogle ScholarPubMed
Kahneman, D. and Frederick, S. (2002). Representativeness revisited: attribute substitution in intuitive judgement. In Heuristics and Biases: The Psychology of Intuitive Judgement, ed. Gilovich, T., Griffin, D. and Kahneman, D.. Cambridge: Cambridge University Press, pp. 49–81.CrossRefGoogle Scholar
Kahneman, D. and Tversky, A. (1984). Choices, values and frames. American Psychologist, 39, 341–50.CrossRefGoogle Scholar
Kleinmuntz, B. (1990). Why we still use our heads instead of formulas: toward an integrative approach. Psychological Bulletin, 107, 296–310.CrossRefGoogle ScholarPubMed
Lloyd, A. (2001). The extent of patients' understanding of the risk of treatments. Quality in Health Care, 10, (Suppl. 1), i14–i18.CrossRefGoogle ScholarPubMed
Lloyd, A., Hayes, P., Bell, P. R. F. and Naylor, Ross A. (2001). The role of risk and benefit perception in informed consent for surgery. Medical Decision Making, 21, 141–9.CrossRefGoogle ScholarPubMed
Marshall, M., Shekelle, P., Brook, R. and Leatherman, S. (2000). Dying to Know: Public Release of Information about Quality of Health Care. Santa Monica: RAND Corporation and The Nuffield Trust. www.rand.org/publications/MR/MR1255/.Google Scholar
Moskowitz, G. B., Skurnik, I. and Galinsey, A. D. (1999). The history of dual-process notions, and the future of preconscious control. In Dual-Process Theories in Social Psychology, ed. Chaiken, S. and Trope, Y., New York: The Guilford Press, pp. 12–36.Google Scholar
Mosteller, F. and Youtz, C. (1990). Quantifying probabilistic expressions. Statistical Science, 5, 2–34.CrossRefGoogle Scholar
Neil, D., Clarke, S. and Oakley, J. (2004). Public reporting of individual surgeon performance information: United Kingdom developments and Australian issues. Medical Journal of Australia, 181, 266–8.Google ScholarPubMed
New York State Department of Health (2005). Adult Cardiac Surgery in New York State 2001–2003. http://www.health.state.ny.us/nysdoh/heart/pdf/2001-2003_cabg.pdf.
Paling, J. (2003). Strategies to help patients understand risks. British Medical Journal, 327, 745–8.CrossRefGoogle ScholarPubMed
Royal Statistical Society Working Party on Performance Monitoring in the Public Services (2005). Performance indicators: good, bad and ugly. Journal of the Royal Statistical Society, Series A, 168, Part 1, 1–27.CrossRef
Schwartz, S. (1994). Heuristics and biases in medical judgement and decision making. In Applications of Heuristics and Biases to Social Issues, ed. Heath, L., Tindale, R. Scott, Edwards, J.et al. New York: Plenum Press, pp. 45–72.CrossRefGoogle Scholar
Slovic, P., Finucane, M., Peters, E. and MacGregor, D. G. (2002). The affect heuristic. In Heuristics and Biases: the Psychology of Intuitive Judgement, ed. Gilovich, T., Griffin, D. and Kahneman, D.. Cambridge: Cambridge University Press, pp. 397–420.CrossRefGoogle Scholar
Stanovich, K. and West, R. (2002). Individual differences in reasoning: implications for the rationality debate. In Heuristics and Biases: the Psychology of Intuitive Judgement, ed. Gilovich, T., Griffin, D. and Kahneman, D.. Cambridge: Cambridge University Press, pp. 421–40.CrossRefGoogle Scholar
Thompson, W. C. (1996). Research on human judgement and decision making: implications for informed consent and institutional review. In Research Ethics: A Psychological Approach, ed. Stanley, B. H., Sieber, J. E. and Melton, G. B.. Lincoln: University of Nebraska Press, pp. 37–72.Google Scholar
Tversky, A. and Kahneman, D. (1974). Judgement under uncertainty: heuristics and biases. Science, 185, 1124–31.CrossRefGoogle ScholarPubMed
Tversky, A. and Kahneman, D. (1983). Extensional versus intuitive reasoning: the conjunction fallacy in probability judgement. Psychological Review, 90, 293–315.CrossRefGoogle Scholar
Wilson, T. D. and Brekke, N. (1994). Mental contamination and mental correction: unwanted influences on judgements and evaluations. Psychological Bulletin, 116, 117–42.CrossRefGoogle ScholarPubMed
Yamagishi, K. (1997). When a 12.86% mortality is more dangerous than 24.14%: implications for risk communication. Applied Cognitive Psychology, 11, 495–506.3.0.CO;2-J>CrossRefGoogle Scholar

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