Lee Memorial Hospital, Ft. Myers Florida. This 330 bed acute care hospital is highly regarded by the folks in Lee County, but you won't find it on the "best hospital" list. Photo by Blogfinger
By Paul Goldfinger, MD, FACC
About 15 years ago, a patient I knew had a heart operation performed at a prestigious New York City university medical center. While he was there, he sustained a life threatening infectious complication due to an error, resulting in an extra 2 ½ weeks in the hospital.
This story illustrates that you can be a patient in one of the best hospitals in the world and still have a substantial risk of a medical mistake. It is estimated that about 33% of hospitalized patients have an adverse result, and this may be an underestimation. USA Today has reported (August 7, 2011) on Medicare data that shows high death rates in some prestigious institutions. USA today article regarding errors in top hospitals
No doubt you have seen magazine articles about which hospitals are the “best”, but what defines “best”, and how can these lists help you when most hospitals are not listed? Furthermore, how can a hospital with high death rates be considered “best? And finally, can your local hospital provide excellent care even if it is not on the list?
Most medical situations that require hospitalization include common elective and emergency situations such as surgery for gall bladder disease, medical management of diverticulitis, and acute therapy for a heart attack. Obviously, if you have an urgent condition, you most go local. But when things become elective, you have a choice.
In my opinion, most issues that require hospitalization can be ably and safely done in a community hospital provided that hospital is known to follow stringent safety and quality protocols. A fine community hospital hires the best staff it can find— especially in the area of nursing; it properly staffs the med-surg floors; it has modern equipment; it places the patient’s interest first and treats patients as individuals; and it has a board certified medical staff , ideally including hospitalists.
If you have such a hospital in your area, and there are many such places, and if you do not require technologies or expertise that are only available at major centers, then go to your nearby hospital and stay away from the massive institutions where you can get into trouble despite their fine reputations.
How to be sure about your local hospital? You could find information within Medicare’s data bank, at the web site for the American Hospital Association or in the sub-data lists of publications such as US News and World Report, but the information is difficult to translate into an individual decision. Aside from the “best ” lists, many hospitals are simply categorized as “average.” What can you do with that?
At this point in time, the only other answer is to speak to medical professionals in your area, check the internet for information, and ask former patients. There’s a good chance that you will discover that your local hospital will serve your needs admirably. But if you have a rare and baffling problem, then get on a plane to the Mayo Clinic (Rochester, Minnesota) or any other hospital on the “best” list that has a special interest in your condition.
Good point, Charles. But what has been interesting and amusing to me is in the 26+ years I have been enrolled in HMO and PPO health plans, the role of the primary physician has become almost extinct. For the last 10 years, none of my plans have required referrals from my primary doctor. I have one, but the only thing he really does for me is give me a yearly TB test required for the continued one of my medications. I list his name, address, phone and fax numbers for all my specialists, but my rheumatologist is the doctor who really acts as my primary, since he prescribes the majority of my drugs and knows what I can take for, say, an upper respiratory infection that won’t case a negative interaction.
Given the fact that so many health plans don’t require a referral to see a specialist, it’s no wonder why the amount of medical school graduates are not choosing general/family practice or internal medicine.
MB: One trend in medicine which i don’t like is the fact that many docs, especially internists and GP’s, no longer go to the hospital when their patients are admitted. That always had been considered an essential component of hospital care, even if the patient was in the hands of a specialist. Of course the doctor patient relationship is important, but it has been eroded over time by managed care. I’m worried that Obamacare will continue the trend to deny doctors control over what kinds of care their patients receive. Certainly some regulation will be needed, but we are still waiting to hear the details regarding how medicine will be practiced in the trenches. Paul
I’ve done both. When I hurt my back, I went to the Hospital for Special Surgery, who diagnosed me (correctly) with a herniated L3 disk that was pinching a nerve. I did three epidurals which were unsuccessful, and was told that they pretty much couldn’t help me without back surgery. Unable to stand the pain, I went to see Dr. Aasim Khan at Jersey Shore, who prescribed Neurontin and basically gave me my life back.
On the flip side, when I was admitted through the ER to Jersey Shore after collapsing at work in February with horrific abdominal pain, not only were they not able to find my “snowstorm” ulcer, since I had roux-en-Y gastric bypass, the folks at Jersey Shore told me they would have to refer me to a facility that treated post-gastric-bypass patients, because they have not performed that procedure there for many years. My employer, American Express, maintains its own list of preferred physicians, so I chose a gastroenterologist from that list who practices at NYU and confirmed that he had, indeed, worked with gastric bypass patients, and had my blood testing, ultrasound and endoscopy/biopsy done at NYU. The ulcer was already healing, but Dr. Laufer conferred with my RA specialist to try a new drug for arthritis pain that is basically a high dose of Aleve coated in Prevacid and added an extra dose of Prevacid daily, and discontinued the 3,200mgs of ibuprofen I was taking for knee pain that was preventing the ulcer from healing.
Having dealt for the last seven years with my medical issues and with my father’s cardiac issues since 1993, in my humble opinion, it’s not the name on the building but the relationship with the physician that is most important when it comes to healthcare. I’ve been an inpatient in both Monmouth Medical Center and Jersey Shore; even though Monmouth could deal with my sliced-and-stapled digestive system, I personally would choose Jersey Shore simply because it was sparkling clean. (No disrespect intended to anyone reading who may work in housekeeping at Monmouth – perhaps, when I had my neck surgery there, Environmental Services was just short staffed.) My mother has worked at Abington Memorial Hospital outside Philadelphia for over 30 years, and my parents and I have all been hospitalized there, with experiences good and bad.
We are very fortunate here in the Northeast to have so many hospital options; in rural areas of America, many communities have a small community general hospital and severely ill patients have to be transported many miles and hours away for speciaized care.
But, Paul, I still think that “the best” is individual unto each person. Medical care can’t be measured like car safety ratings; there are too many variables, the biggest of which is doctor-patient rapport, to be considered.