Maintaining Patients’ Trust.

We hope this book will be of interest to patients, the public, members of the Society for Cardiothoracic Surgery in GB and Ireland (SCTS) and to colleagues in the medical profession. The book has been written in three parts. In the first we tell how SCTS has moved from informal paper-based data collection to a comprehensive and audited electronic database of all adult cardiac surgical operations in England, Wales, Scotland, Northern Ireland and Eire. And how, from this database we have placed outcomes, including surgeon specific results, in the public domain. We describe the important improvements in quality that we have seen as a consequence of collection, analysis and publication of this data (whilst acknowledging that we must also ensure that there are sufficient safeguards to ensure that patients receive appropriate treatment). Whilst these are substantial achievements we also recognize that we must guard against complacency in the face of changing medical professionalism and increasing expectations of patients in a more transparent society. In the second part we have therefore invited some internal SCTS and external contributions to look at wider aspects of medical professionalism. Whilst these do not represent current SCTS policy they provide interesting insights that will influence our thinking in future. We are equally aware that some of these concepts may currently seem challenging but so was the concept of publishing surgeon specific data when initially debated more than a decade ago. Many other areas of medicine are interested in developing their own professionally led national audits. A question we are often asked is about the cost of the SCTS endeavour. The third part of the book therefore contains our estimate of the resources necessary for us to fund our current model.