[prmph]

But here's the things I'm not clear about: Surgeon get immediate feedback if they make mistakes because their patient might die or get severely disabled, but is there any feedback to GPs about the effectiveness of their work?

Let's say someone is not treated that well by his doctor for a chronic condition. He gets to the emergency in a different hospital and probably dies. Does his GP get to know about it?

For example, many doctors in my country believe that Left Ventricular Hypertrophy (LVH) on an ECG is nothing much to worry about, as long as there is no anatomical LVH showing up on an Echocardiogram. Yet, study after study online concludes that ECG LVH is a serious marker of cardiac pathology distinct from (but related to) from anatomical LVH.

How do doctors who operate on this assumption going to learn from experience, if they mostly don't know that their patients have cardiac events as a result?

[Calavar]

> Surgeon get immediate feedback if they make mistakes because their patient might die or get severely disabled, but is there any feedback to GPs about the effectiveness of their work?

I disagree with this. If a patient dies from a surgical complication, it is often weeks or months later, on a nonsurgical service because there are no surgical options left for the patient.

> Let's say someone is not treated that well by his doctor for a chronic condition. He gets to the emergency in a different hospital and probably dies. Does his GP get to know about it?

Yes, they get to know about it. But ascribing cause and effect in a chronic disease is difficult.

Eventually everyone will die, even if they get perfect treatment. I'm not saying there's no such thing as medical error - in some cases there is clear and obvious error - but what's much more common is a situation of "Did I do the wrong thing, or did I do the right thing but they were so sick that they died anyway?" And there are often many years separating cause and effect, which muddies the picture even further. That's why learning from specific patient outcomes is tricky and why doctors lean so heavily on evidence based medicine, which means learning from large medical trials with rigorous statistical controls.

> For example, many doctors in my country believe that Left Ventricular Hypertrophy (LVH) on an ECG is nothing much to worry about, as long as there is no anatomical LVH showing up on an Echocardiogram. Yet, study after study online concludes that ECG LVH is a serious marker of cardiac pathology distinct from (but related to) from anatomical LVH.

There's a difference between serious pathology and serious pathology you can do something about. I agree that LVH on EKG is a bad sign, even if the ultrasound is normal. But what is your GP going to do about it? There are many test results that are abnormal and/or correlated with bad outcomes, but only a subset of those can be labeled with a concrete diagnosis that is well understood medically, and only a subset of those can be treated.

All your GP can do for an ECG finding of LVH is advise blood pressure control, cholesterol control, exercising frequently, and other things that are generally good for heart health.

On the other hand, if there is anatomical LVH, then the next question is whether there's hypertrophic obstructive cardiomyopathy. That's a concrete diagnosis where we know a lot about the underlying mechanism, which leads to specific advice like avoiding strenuous activity. And some patients with HOCM can benefit from a septal ablation. That's why anatomic LVH gets more attention from doctors.

[prmph]

> Yes, they get to know about it.

I’m curious. How do they get to know about it? Maybe the process differs between countries. I’m from Ghana, by the way.

> All your GP can do for an ECG finding of LVH is advise blood pressure control, cholesterol control, exercising frequently, and other things that are generally good for heart health

Mostly true, but taking ECG LVH more seriously helps the patient understand how important it is for them to improve their general heart health. It also makes LVH regression (which is possible in more cases than doctors believe) a therapeutic target.

[Calavar]

I'm in the US. Part of my hospital's workflow for a deceased patient is calling their GP's office to notify them of the death. As far as I am aware, this is mandated by state law. If a patient is discharged, a summary of their hospital course is faxed to their GP's office at the time of discharge. Or transmitted electronically, if possible.

[eszed]

What is the GP expected to do with that? Does the doctor (ideally) review case notes and their own interventions? Or does the office staff close the patient's file - without necessarily even telling the doctor "Mr So-and-so passed away", unless it happens to come up in conversation?

Genuine question, and I can see totally valid reasons for each course of action.

[Calavar]

It's up to them what they do with the information. Ideally the doctor would take the opportunity review the patient's chart, but I'm sure there are some clinics that just close the file and call it a day.

The feedback loop tends to be stronger on the inpatient side. In academic settings, it's common for each department to have a "morbidity and mortality" conference once or twice a month. This is a meeting where one or two physicians will present a case that they think went poorly and the rest of the physicians in attendance will give feedback on what could have been done differently.

[xyzzy123]

Surgeons don't get immediate feedback because the advisability of procedure X ends up being a statistical matter that might not be decided in the surgeon's lifetime. It depends what it is. They will have opinions of course, but will work with the system and follow process.

[dimatura]

I don't know about GPs, but for surgeons I believe it's not so clear cut (pun not intended). From what I understand bad outcomes in surgery often take a while to manifest - but more importantly, it seems that even when they do, and get tracked in the medical record, not much is done about it either way. I recall reading an article a while back about investigations showing there's a wide disparity in outcomes among surgeons, but not much is done about it, and there's no way for patients to get access to this data. This was several years ago, though, so maybe things have changed since then.

[specialist]

The importance of "feedback loops" was my key takeaway from my time larping as a QA/Test manager.

> ...but is there any feedback to GPs about the effectiveness of their work?

Specialties too. esp for any misdiagnosis or hard to diagnosis conditions.