Towards a Sociology of Disclosure: The Case of Surgical Performance

Despite the increasingly widespread emphasis on the need for transparency in health-care and elsewhere, there is limited evidence regarding the consequences of disclosing medical performance data. The evidence is disparate and has not been synthesised in a coherent way. This paper focuses on surgical performance, whose measurement is generally often seen as straight forward. It begins by outlining the context for understanding the publication of such data and then presents an analytical framework as a vehicle for conceptualising the nature of disclosure in surgery and health-care more generally. The framework addresses key dimensions concerning one surgical specialty (cardiac surgery) and its relationship with a range of stakeholders in an English context. In particular, we examine the interaction between surgeons and between surgeons, patients, managers and policy-makers. These relationships are framed in terms of choice and calculativeness, strategies and tactics, and trust, and need to be understood at micro, meso and macro levels. We conclude by considering how this framework provides a research agenda for a sociology of disclosure.