To the Editor: The conclusion in the article by Bridgewater et al~1 that mandatory reporting and public scrutiny have not resulted in risk-averse behaviour but rather have improved surgeons' performance is simply wishful thinking not supported by data from other quality-driven states such as New York.~2 A more likely explanation for their findings is that public scrutiny increased the pressure to assign higher EuroSCORES, so despite the fact that they operated on patients at lower risk (as shown by the lower mortality), the predicted mortality was higher.
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