Hopes and dreams for quality improvement in radical prostatectomy

• Published in: Oncology (Williston Park, N.Y.) Vol. 26; no. 7; pp. 630, 635 - 635
• Main Authors: Maroni, Paul, Phillips, Jason M
• Format: Journal Article
• Language: English
• Published: United States Intellisphere, LLC 01.07.2012; MultiMedia Healthcare Inc
• Subjects: Clinical Competence; Ethical aspects; Health aspects; Humans; Male; Medical care; Medicine; Practice; Prostatectomy; Prostatectomy - methods; Quality management
• ISSN: 0890-9091; 2767-7389

How does Dr. X (a surgeon who performs radical prostatectomies) ascertain whether he/she would qualify as "skilled" at performing this operation? This determination requires timely feedback about clinically important outcomes and a source for comparison. Outcomes in radical prostatectomy have proven quite challenging to measure; obligatory long surveys and distant time-points necessitate a considerable commitment of resources. I find it doubtful that the average surgeon performing radical prostatectomy makes this investment, but assume that Dr. X, unlike his competitors in the community (who sadly are more the norm in medicine today), meticulously monitors his patients. Dr. X presents outcomes honestly to patients, something that is notably difficult at the beginning of his/her career, since he/she received no feedback from his/her training experience; however, after years he/she can finally measure outcomes against published series. The results are mediocre. Dr. X begins a long series of educational activities to improve technique. After years of colossal effort, the outcomes have improved, but they remain relatively inferior. He/ she rationalizes and comes up with all sorts of "explanations" for the results, some of which are reasonablefor instance, patient selection, the instruments used for assessment, and the unknown outcomes of the enormous number of unmonitored patients. Ultimately, however, the inability to make an effective comparison results in ambiguity.