Surgeons are being urged to disclose their rates of surgical complications to prove they're worth the premium fees they charge, and to help patients make informed decisions about the doctors they choose.
Obstetrician and gynaecologist Professor Stephen Robson has broken ranks with the surgical profession by publishing his surgical outcomes data for any potential patient, referring GP or colleague to scrutinise.
His bold move has been commended by Australia's Chief Medical Officer Professor Brendan Murphy and public health experts who have long called for an end to surgeons guarding data on their outcomes from public view.
"Surgery is like sex: everyone talks up their performance," Professor Robson said. "But getting the objective data to verify their claims is much harder to come by."
"When something is veiled in secrecy it can feed mistrust and anxiety," he said.
Surgeons are required to conduct yearly surgical audits of their surgical outcomes and submit them for peer review as a condition of their registration. But of the more than 7000 surgeons across Australia, the number who publicly share this information is likely to be in the single digits, Professor Murphy said.
There has been growing concern patients and advocates over patients crowdfunding, re-mortgaging homes or draining superannuation to cover out-of-pocket medical bills. A federal government inquiry into those out-of-pocket costs prompted the creation of an opt-in specialist fees transparency website, which is expected to go live by the end of the year.
"Any doctor claiming superiority has an obligation to provide the data to back that up," Professor Murphy said. "The overall standard of surgeons in Australia is very good, but there are some surgeons at the top of their specialties that are probably worth paying more for, and they are certainly not necessarily the people currently charging very high fees," he said.
Conversely, Professor Robson said, "we don't want a situation where patients go with the lowest bidder irrespective of the standard of care on offer".
Adverse outcomes are a possibility with any surgical treatment, no matter who's doing it. That doesn't mean they're a bad surgeon.Professor Stephen Robson
It took two decades in the profession and months of deliberation before Professor Robson published a five-year audit of his surgical practice on his website, detailing the number of surgeries he performed and benchmarking his complications rates against clinical indicators published by the Australian Council on Health Standards.
"I just thought 'oh bugger it'. It's time for me to help patients make an informed decision about the quality of care they get and maybe I can inspire my colleagues to do the same," he said.
He understood why many surgeons were anxious about disclosing their complications. "Your reputation is everything ... but surgery can never be perfect," he said.
"Adverse outcomes are a possibility with any surgical treatment, no matter who's doing it. That doesn't mean they're a bad surgeon," he said.
Professor Murphy said the strong resistance from the surgical profession was predominantly rooted in fears about how the data would be interpreted.
He said being transparent about surgical complications was "incredibly important" but it was "incredibly difficult" to get right and adjust for the level of complexity of different surgeries and patient prognoses.
"But we need to overcome these difficulties because the public has a right to transparent and accurate information," Professor Murphy said.
The ideal scenario would involve a central register where surgeons' outcomes were uniformly vetted and benchmarked and risk-adjusted against validated measures so as not to disadvantage surgeons who take on a high volume of the most complex cases with a higher risk of complications, he said, but this was "a fair way off".
Economist Dr Stephen Duckett, health program director for think-tank the Grattan Institute, said the move by individual specialists to self-publish their outcomes proved it could and should be done.
"For too long doctors have been saying it's not possible and using the statistical difficulties of risk-adjusting as an excuse not to do it," Dr Duckett said.
He suspected some surgeons opposed greater transparency because they knew their results would not stack up against their peers.
Ideally, surgical complications data would be made publicly available by all public hospitals and individual surgeons operating in the private sector, Dr Duckett said.
"For a patient, being able to know which doctors have lower complications rates, mortality rates and referrals to ICU is an unequivocal benefit," Dr Duckett said.
There was also a cost-benefit for private health insurers if they disclosed surgeons' complications rates to members, driving greater numbers of patients to the better performing surgeons.
"It then becomes the responsibility of the health insurers ... they know poor quality healthcare costs more than good quality care," he said.
Professor Robson argued any move towards greater outcomes transparency should be led by the profession rather than imposed by government or health insurers.
Some surgeons in Queensland have baulked at moves by the state government to impose a hospital-based rate-and-compare website, warning surgeons would avoid higher-risk operations.
"If more surgeons start offering this it will soon seem like a natural part of practice and patients will have more faith in the care they are receiving," he said.