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Canadian Medical Association Journal
CMAJ - May 19, 1998 JAMC - le 19 mai 1998

Letting the public know

CMAJ 1998;158:1266

See response from: B. Taylor, W.J.S. Marshall
I read with interest the article "Common bile duct injury during laparoscopic cholecystectomy in Ontario: Does ICD-10 coding indicate true incidence?" (CMAJ 1998;158[4]:481-5 [abstract / résumé]), by Dr. Bryce Taylor, and the editorial "Administrative databases: Fact or fiction?" (CMAJ 1998;158[4]:489-100 [full text]), by Dr. W. John S. Marshall. As a scientist who has been engaged in health services research for over a decade and who is engaged to a journalist who has written about laparoscopic surgery in the popular press, I have a unique, though perhaps not unbiased, perspective on the issues these authors raise about research into quality of care and the responsibilities of researchers, peer reviewers, editors, the media and the medical profession.

As both Taylor and Marshall point out, researchers developed an approach to measure what they called "bile duct injuries" that was first used in 2 peer-reviewed studies1,2 and was reported in a story published in the Toronto Star.3 The newspaper story was consistent with the peer-reviewed publications in suggesting a potentially serious quality-of-care issue, but only the newspaper story identified specific hospitals. That story, but not the peer-reviewed publications, generated a heated public response from the medical profession.

Taylor undertook his study after the newspaper story had been published. As he acknowledges, his work was not designed to estimate accurately the number of bile duct injuries in Ontario but rather to evaluate the approach used in the earlier studies.1,2 He concluded that there had been problems with that approach. His systematic questioning of previous research is a normal component of scientific progress and debate. He did not criticize the researchers who did the original work, the reviewers and editors who endorsed it, or the journalist who responded to the quality-of-care issue they first identified.

Ultimately, Taylor, Marshall and the journalist all agreed that public accountability is important and that there is a real need to give the public accurate information on quality of care. We need to understand that researchers face a learning curve in developing ways to produce that information. Furthermore, we should not be surprised if journalists and the public have a keen interest in research on quality of care. Public accountability means just that — letting the public know. It means naming names rather than hiding behind anonymous data, and it means publicizing existing peer-reviewed research rather than waiting, perhaps forever, until we find the perfect way to measure quality of care.

Geoffrey M. Anderson, MD, PhD
Associate Professor
Department of Health Administration
Faculty of Medicine
University of Toronto
Toronto, Ont.
geoff.anderson@utoronto.ca

References

  1. Cohen MM, Young W, Thériault ME, Hernandez R. Has laparoscopic cholecystectomy changed patterns of practice and patient outcome in Ontario? CMAJ 1996;154(4):491-500.
  2. Cohen MM, Young W. Complications after laparoscopic cholecystectomy. In: Goel V, Williams JI, Anderson GM, Blackstien-Hirsh P, Fooks C, Naylor CD, editors. Patterns of health care in Ontario. The ICES practice atlas. 2nd ed. Ottawa: Canadian Medical Association; 1996. p. 187-10 0.
  3. Priest L. The low-scar surgery with a high risk. Toronto Star 1997 Sept 21; Sect A:1,14,15.

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