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Commentary: Patient perspective on data tells a different story
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The study published in the November issue of Ophthalmology concerning risk factors for LASIK lawsuits raises some serious concerns, not for what it says, but for how it appears to be interpreted. The principal author of the 6-year retrospective study, Richard L. Abbott, MD, explained that the purpose of the study was to identify physician risk factors in LASIK and PRK surgery that correlate with a higher liability for claims and lawsuits.
In his presentation before the American Academy of Ophthalmology’s International Society of Refractive Surgery meeting, Dr. Abbott stated that the goal of the study was to provide “statistically significant data for underwriting criteria.” In other words, the study was designed to assist insurers in their attempts to price insurance premiums and identify high-risk physicians. The study finds that there is a significant correlation between high surgical volume and the chances of incurring a claim or a suit. Using an extreme example, the study tells us that a physician who performs 10,000 surgeries has a greater chance of being sued than a physician who performs only 100. That is intuitive; no one should be surprised by that finding.
Different interpretation
The study results, however, are being interpreted to draw different conclusions. Press reports about the study suggest that the likelihood of a patient having a bad result is greater with a high-volume surgeon. After all, look at the title of the article accompanying this editorial, which was based upon Dr. Abbott’s ISRS presentation. Anyone who reads that headline would presume the study shows that a high-volume surgeon creates higher risk for the patient. But that is not what the study shows. In fact, one who analyzes the study data would find that it supports the conclusion that high-volume surgeons present less risk for patients. This important finding is consistent with a study published in the New England Journal of Medicine in November, which found that higher volume surgeons have a lower mortality rate than other surgeons. But that conclusion is not presented anywhere in the Abbott study.
This issue was raised during Dr. Abbott’s presentation at the meeting. The moderator, Eric D. Donnenfeld, MD, asked Dr. Abbott: “Putting on the patient hat, if a patient were going to go to a doctor for LASIK surgery, what is the risk per patient encounter for having a complication? When I reviewed your data, it seemed that the highest volume doctors had the least risk per patient, suggesting that the more experienced surgeons have less risk of lawsuit per patient.”
Dr. Abbott responded: “It’s a good point. We didn’t specifically look at it that way.”
The study looked at the data through the eyes of the insurer in order to determine the risks related to physicians who apply for coverage. The study did not look at the data through the eyes of the patient who seeks to identify surgeons where the risk of a complication will be low. The study data show that those two perspectives produce significantly different results. Care must be taken to assure that patients and physicians are not misled by the results reported in this study.
For Your Information:
- Alan E. Reider, JD, can be reached at Arent Fox Kintner Plotkin & Kahn, PLLC, 1050 Connecticut Ave. NW, Washington, DC 20036; 202-857-6462; fax: 202-857-6395.