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Disclosure of Individual Surgeon's Performance Rates During Informed Consent: Ethical and Epistemological Considerations

Burger, Ingrid BS*; Schill, Kathryn MA*; Goodman, Steven MD, PhD

doi: 10.1097/01.sla.0000242713.82125.d1
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Objective: The purpose of the paper is to examine the ethical arguments for and against disclosing surgeon-specific performance rates to patients during informed consent, and to examine the challenges that generating and using performance rates entail.

Methods: Ethical, legal, and statistical theory is explored to approach the question of whether, when, and how surgeons should disclosure their personal performance rates to patients. The main ethical question addressed is what type of information surgeons owe their patients during informed consent. This question comprises 3 related, ethically relevant considerations that are explored in detail: 1) Does surgeon-specific performance information enhance patient decision-making? 2) Do patients want this type of information? 3) How do the potential benefits of disclosure balance against the risks?

Results: Calculating individual performance measures requires tradeoffs and involves inherent uncertainty. There is a lack of evidence regarding whether patients want this information, whether it facilitates their decision-making for surgery, and how it is best communicated to them. Disclosure of personal performance rates during informed consent has the potential benefits of enhancing patient autonomy, improving patient decision-making, and improving quality of care. The major risks of disclosure include inaccurate and misleading performance rates, avoidance of high-risk cases, unjust damage to surgeon's reputations, and jeopardized patient trust.

Conclusion: At this time, we think that, for most conditions, surgical procedures, and outcomes, the accuracy of surgeon- and patient-specific performance rates is illusory, obviating the ethical obligation to communicate them as part of the informed consent process. Nonetheless, the surgical profession has the duty to develop information systems that allow for performance to be evaluated to a high degree of accuracy. In the meantime, patients should be informed of the quantity of procedures their surgeons have performed, providing an idea of the surgeon's experience and qualitative idea of potential risk.

Public disclosure of surgeon-specific performance ratings has grown over the past decades as part of the trend to improve the quality of health care and empower patients to make better-informed medical decisions. This paper examines the ethical arguments for and against disclosure during informed consent as well as the challenges that generating and using performance information entail.

From the *Phoebe R. Berman Bioethics Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and the †Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health.

Reprints: Ingrid Burger, BS, Phoebe R. Berman Bioethics Institute, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Rm. 344, Baltimore, MD 21205. E-mail: iburger@jhsph.edu.

© 2007 Lippincott Williams & Wilkins, Inc.