A SENIOR specialist's call for doctors to publish their surgical complication rates to improve transparency in the health system has been challenged by a former Australian Medical Association president because of concerns doctors might "game" the data.
Former AMA president Michael Gannon said he had no doubt about the "massive information imbalance" that causes "extreme difficulty for patients" requiring surgery, and it is "probably more difficult now than it used to be".
But former Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) president Stephen Robson's decision to publish his surgical outcomes data on his website was not the answer, said Dr Gannon, an obstetrician and gynaecologist.
"I have concerns about how people might choose to game data like this, and by people I mean doctors," he said.
"The reality of private medical practice is it's a competitive market. There are obstetricians who boast they don't look after women over a certain weight. That way they have fewer complications. The self-regulated, unmediated data would not reflect that kind of decision-making and would disadvantage people who don't apply those kinds of restrictions."
On Tuesday, as RANZCOG members met in Melbourne for their annual scientific conference, Dr Robson said it was time to increase transparency in the health system and end the secrecy about doctors and their surgical outcomes.
"Surgery is like sex; everyone talks up their performance," Dr Robson was quoted saying.
"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."
His comments came only weeks after consumer health groups raised serious concerns about a doctors' insurers' proposal to a NSW Government review that will lead to even less public scrutiny of problem doctors.
Australia's biggest doctors' insurer group, Avant Mutual, has told a NSW Justice review that the NSW Civil and Administrative Tribunal (NCAT) should be given expanded powers to dispense with public hearings in disciplinary actions against doctors, including professional misconduct, where they retire or voluntarily deregister before proceedings, or admit to complaints.
Health consumer advocates and patients left injured after surgery by Hunter eye specialist Eugene Hollenbach, or following pelvic mesh implants, said the public had no way of knowing doctors' complaint histories until after things went wrong.
Dr Gannon said there were "surgeons who have no insight about their abilities" and regulators including the Australian Health Practitioner Regulatory Agency missed "the sweet spot" of acting strongly and quickly against problem doctors who were a risk to the public.
"The minority of people doing harm seem to be out there for longer than we would like," he said.
There were also "individual doctors putting themselves out as being better than their colleagues, and charging five-figure sums", he said.
But while he had respect for Dr Robson as a clinician and colleague, "I think that like so many issues this is more complicated than it looks", Dr Gannon said.
"I have concerns about a future where doctors would selectively represent their data to seek to attract patients.
"I would have to think I'm at the right end of the bell curve in terms of my own practice but I'm not convinced it's ethical behaviour to assert that.
"We don't want a situation where there is a group of practitioners in the eastern suburbs of Sydney who use self-regulated data to say they are 'better' than practitioners in other parts of NSW."