Letting the public know
CMAJ 1998;158:1268
In response to: G.M. Anderson
The popular press undoubtedly played an important role in focusing on an apparently important issue of quality of care. As events unfolded, however, the newspaper story was misdirected: the fault lay not in the quality of care by Ontario's general surgeons, but in the coding system for documenting complications. The newspaper article was correct, therefore, in recognizing a discrepancy that should have been investigated, and the scientific community (general surgeons, CMAJ and the Institute for Clinical Evaluative Sciences [ICES] included) could learn from that method of intense investigative reporting. However, we must remember that although accountability to the patient is of prime importance, the concern, fear and outright paranoia that can be generated can, in the end, be counterproductive. Ironically, we are now concerned that patients will present with life-threatening complications of their gallstone disease that could have been avoided if they had not ignored, on the basis of the newspaper article, their surgeons' advice to undergo elective cholecystectomy. That reaction is not surprising, given that phrases such as "slashed bile ducts" were used repeatedly to characterize what turned out to be, in over 90% of cases, coding notations of events inconsequential to patient outcome.
I support the pursuit of truth and the naming of names; however, if names are to be named it is all the more important that the truth be established first. The authors of the original article stated that their finding should be investigated further.1 If such an investigation had been carried out more quickly by the scientific community, the truth would have come to light and perhaps the recent over-reaction avoided. We can only hope that the scientific community, in the speed with which it seeks the truth, and the lay press, in its sense of responsibility and methodology, will both do better next time.
On the subject of responsibility, I must commend Mr. John Honderich, publisher of the Toronto Star. After completing my independent review, I was encouraged to submit an article for publication in CMAJ because of the potential value of my conclusions to the scientific community in general and to medical records departments in particular for future assessments of computerized data from the Canadian Institute for Health Information. While the article was in peer review, the Star quite legitimately wanted to publish my findings to clear the air. Such a premature account would have made publication in CMAJ impossible. A personal plea to Mr. Honderich received a sympathetic and gracious response; he simply wanted the truth to come out, and he assured me that the Star would withhold the story until after CMAJ's embargo date. That experience convinced me that the scientific press and the popular press have the same objectives after all.
Bryce Taylor, MD
Professor
Department of Surgery
Chairman, Division of General Surgery
University of Toronto
Toronto, Ont.
btaylor@torhosp.toronto
.on.ca
Reference
- 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.
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