Surgical complications correlate with a surgeon's skills as rated by his or her surgical peers. A study in the New England Journal of Medicine showed that the complication rates for bariatric surgeons were 3 to 5 times higher for surgeons rated in the lowest quartile (the lowest rated 25% of surgeons evaluated) compared with the highest quartile (the top rated 25% of surgeons evaluated). Twenty bariatric surgeons in Michigan sent in a representative videotape of a laparoscopic gastric bypass they performed and had their surgical skills evaluated by a panel of surgeons who did not know the identity of the surgeons on the videotape. Peer rating of surgical skills was accurate in so far as those surgeons who rated high had surgical complications of 5% compared with surgeons who rated low with complication rates of 15%. The increased surgical complications included leak, obstruction, infection and hemorrhage.
Diagnostic errors are estimated to occur 10 to 15% of the times with the highest error rates in general care cases where patients are diagnostically undifferentiated, such as emergency rooms, family medicine and internal medicine. The article in the New England Journal of Medicine looked at why so many errors are made. In focused visual specialties such as radiology and pathology, error rates are much lower at 2%. Smart doctors make dumb mistakes when they fail to recognize that they are thinking on an intuitive level rather than on analytical level. That is, even doctors fall victim to cognitive bias which leads them to incorrect diagnoses. For instance, in 55% of fatal cases of pulmonary embolus, the diagnosis was completely missed. The brain processes information on two levels: an intuitive (Type 1) level and an analytical (Type 2) level. Intuitive Type 1 thinking is largely reflexive and autonomous often happening in the blink of an eye. These intuitive thinking patterns (heuristics) are either hard-wired into our brain or acquired through repeated experience. Trusting ones intuition is generally correct but not always. Unless physicians recognize when they are susceptible to Intuitive Type 1 errors, the misdiagnosis rate will not decrease.