June 14, 2010 by sharonbrennan
Throughout Malcolm Gladwell’s 2008 book Outliers, he repeatedly mentions the 10,000 hours rule. Namely that if you want to be a success at something you need to practice that discipline for about 10,000 hours before you can call yourself an expert. A rule that makes us realise that today’s Guardian story, about how death rates from the same routine operation differ across the UK, should really be common sense.
Taking data from surgeons working in 116 hospital trusts, it has found that the smaller the hospital the higher the mortality rate from planned operations. It focuses its story on planned vascular surgery for abdominal aortic aneurysm, otherwise known as an AAA operation, and found that death rates from this surgery vary from under 2 per cent in some hospitals to over 10 per cent in 10 of the hospitals surveyed.
You can read more about it on the Guardian’s site, but one interesting quote from the piece is: “Some leading surgeons believe that for best results, a hospital needs to carry out at least 50 AAA operations a year. Yet very many hospitals across the UK see less than 20 cases a year. Dartford and Gravesham had just five in three years.” It’s logical that if a hospital team has had more practice at something than they are likely to better at it. Perhaps the only reason we are shocked is because it shows that our life is literally in the hands of a surgeon – and we hate to think that surgeons, just like all other people working in different, less life-dependent industries, will be good at some things and not so good at others.
My family learnt this lesson well when I was only two years old. I had to have an operation on my leg. The operation date arrived, my parents took me to hospital and listened to the surgeon as he discussed what he was going to do to make my leg work properly again. After listening to him using phrases such as ‘We might make it worse’, ‘Not sure if I can really do much to improve things’ my parents decided he wasn’t going to ‘have a go’ at my legs. They packed my stuff and walked out of the hospital with me, just a few hours before my operation was due. Thank God because the great surgeon who did eventually make my legs work again did so in a completely different manner to what the rubbish surgeon had suggested!
So what should be done? Firstly, do have respect for your hospital team, but if you’re not convinced by a procedure or a hospital you are allowed to say – it is your body, you have to live with the results.
Secondly, the Guardian article suggested closing down smaller hospitals, but perhaps another route could be ‘shared care’ – something I again have experience of. When I was a teenager growing up with Cystic Fibrosis I regularly attended a clinic at my local Kingston hospital but I went for a biannual consultation at the world-renowned Brompton Hospital in London. I literally got the best of both worlds – a great local team that was conveniently located and knew me really well combined with new ideas and the latest research suggestions from Brompton hospital. In short, each hospital got to do what they were best at. Perhaps a more flexible hospital system of ‘shared care’ might make operations more uniformly safe across the UK while safeguarding local hospitals that we rely so much upon?