I’m serious as a heart attack (boldface mine):
In 1989, New York became the first state in the nation to make public the mortality rates of its heart surgeons. Report cards for two different procedures, coronary bypass and angioplasty, were chosen as the standards by which the entire profession would be judged—a sort of litmus test for the skill of a given surgeon or hospital. The mortality numbers, risk-adjusted by age and other factors, are released every year or so on the Internet and reprinted in newspapers for all to see, hospital by hospital and doctor by doctor. Ending years of private, clubby surgeon culture, the public report cards were intended to shine a light on poor surgeons and encourage a kind of best-practices ethic across the state. If the system worked, mortality rates would fall everywhere from Oswego to NYU.
Paging Dr. Campbell! You can probably guess what happened next (boldface mine):
Consider, for instance, a case that would fall into more of a gray area than that of the 60-year-old TV executive. Let’s say, instead, it’s a much older man, one who comes into the hospital with a massive heart attack, and on top of that he’s in cardiogenic shock, meaning that his blood pressure is dangerously low. If you do nothing, there’s perhaps a 95 percent chance he’ll die; if you give him an angioplasty, the chance of death still lingers at 55 percent. As a cardiologist, do you make a hopeless case only slightly less hopeless, put the patient and family through a dangerous and expensive ordeal, and risk ruining your own mortality rate? Or do you walk away?
…The problem with decisions is that not every doctor makes wise ones—and “futility” is a matter of opinion. David Adams, who came from the Brigham and Women’s Hospital at Harvard a few years ago to chair the heart-surgery program at Mount Sinai, remembers a young woman who came to his office late last spring. Her age and her overall health made her seem like a low risk on paper, but before she’d come to see him she’d had an infection in her heart valve that caused a leak that in turn sent her spiraling into gross heart failure. To take on her case, doctors essentially would have had to rebuild the whole top of her heart. Several surgeons turned her down; whether it was because of the risk of public exposure or the practice of good medicine is an open question.
But in Adams’s office, he has a card from the woman. “How grateful I am,” she writes, “that you said yes . . . when other doctors didn’t want to take the risk.”
This could be a problem.