How to pick the leading physicians of the world

 

My "real life" self has been selected as a Top Surgeon in my city by the International Association of Healthcare Professionals (IAHCP). I will be spotlighted in the renowned publication “The Leading Physicians of the World.” Can you imagine?

As you can see, my candidacy [which I did not know was even a remote possibility] was approved on June 11.

The letter goes on to state that the IAHCP highlights and profiles the world’s Top Surgeons. The association features physicians who have demonstrated success and leadership in their profession. It even provides an opportunity to network, collaborate, and share information with other medical professionals from around the globe. [Just what I need—another social network of physicians.]

Inclusion in the book “The Leading Physicians of the World” is not only a tribute to my success, but is also a valuable resource for potential patients who are looking for a Top Surgeon in their area.

There is no charge for this honor.

I’m sure the organization did a lot of research before it approved my candidacy. I wonder how they missed that I’ve been retired from the practice of surgery for more than two years?

I thought this was remarkable, but last year New York Times writer Dr. Abigail Zuger easily topped me.

Last year, she wrote that a relative of hers had been named one of the world’s top physicians. All he had to do was to verify his biographical information, and he would be included in the same book and online reference mentioned above.

The good doctor wasn’t able to do so because unfortunately, he died 16 years ago.

What have we learned here?

As I have said on many occasions [e.g., here and here], one must take all ratings with a pinch of salt. 

Physician ratings? A truckload of salt.

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Some venous thromboembolic events can’t be prevented even with optimal care

I have written several posts about how I get things right before others see the light, but none better than one from three years ago pointing out that some of the Centers for Medicare and Medicaid Services (CMS) "never events" cant really be completely prevented and therefore should not be considered "never events."

One specific "never event" I questioned was hospital acquired venous thromboembolic (VTE) disease which encompasses deep venous thrombosis (DVT) and/or pulmonary embolism (PE). I wrote "I am unaware of any DVT study in which no patients in the experimental arm developed DVTs or PEs. Patients will develop DVT or PE even with the best evidence-based care."

Along comes a brief research letter published last month in JAMA Surgery by a group from Johns Hopkins led by surgeon Elliott R. Haut.

Of 92 patients in their institution who had VTEs in a single year, 43 (47%) had received defect-free care. That is, each of those patients received all doses of risk-appropriate pharmacological prophylaxis ordered for the entire hospitalization.

To put it another way, VTEs for those 43 patients were not preventable. There would be no way to do a quality improvement project for a group of patients who received the right prophylaxis throughout their hospital stays and still got VTEs.

The Joint Commission/CMS criterion states that a hospital is in compliance with VTE prophylaxis if a patient receives one dose of an appropriate drug within 24 hours of admission. The Hopkins study showed that of the 49 patients (53%) whose care was suboptimal, 36 (73%) missed at least one dose of prophylaxis that was correctly ordered. Other studies have shown that missing even one dose of prophylaxis at any time during a hospitalization increases the risk of VTE.

So about half of VTEs are not preventable even with perfect adherence to the prophylaxis protocol, and the standard for compliance established by the JC/CMS is inadequate to judge the quality of an institutions performance for VTE prevention.

The study shows that 1) a lot of good information can be delivered in a two-page paper, 2) JC/CMS criteria for compliance with VTE prophylaxis need to be revisited, and 3) VTE should be removed from the list of "never events.”

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