I was at book club the other night, pouring another glass of Chardonnay, when my friend told me that in August she was diagnosed with three blocked arteries, one of which is 100 percent blocked. I could rant about the fact that she’s been walking around like this for three months with only a beta blocker and statin as treatment, but that’s fodder for another blog.
When I talked to her she had an appointment with a cardiologist in our area. “Oh, he’s wonderful,” she said. because that’s what she’d heard from other people. What she didn’t realize, however, is that “wonderful” doesn’t mean good. She didn’t know how often he performed the procedure she might need; how well his patients did with or without surgery; what ties he might have to the pharmaceutical or medical device industry that could bias his recommendations; if he’d had any malpractice suits against him and how they’d turned out.
Choosing a doctor based only on what your friends tell you is like buying a car based on its color, something few of us would do. Instead, we research cars to find out which gets the best gas mileage, its safety record, its cost. Then we compare cars and choose the one that’s right for us.
Compare that to how we “buy” medical care. We typically have no idea how well or how often a doctor performs a procedure, what a hospital’s infection rate is, even the key things doctors and hospitals should do to reduce the risk of complications or death.
That’s because there is no transparency in health care. We, the customer, can rarely find out the cost of the care we receive or the quality.
That’s changing somewhat as we shift from a paternalistic, provider-centered healthcare system to a patient-centered healthcare system, in which patients have access to more information and data so they can make more informed choices.
Today there are some places you can go to check on your doctor or hospital. At Hospital Compare, for instance, you’ll find a searchable database on the quality of care at over 4,000 Medicare-certified hospitals, including how well hospitals do at providing timely, evidence-based care; their readmission, complication, and death rates; and patient satisfaction. Beginning next year, you’ll be able to find quality data on physicians who participate with Medicare at Physician Compare. The Centers for Medicare & Medicaid Services (CMS) also provides quality data on nursing homes, home health agencies, and dialysis centers.
I urge you to check out these sites before choosing a hospital, physician, nursing home, home health agency, or dialysis center. I also urge you to search for quality databases on specific procedures, such as the coronary artery bypass graft my friend may need. I found a quality database at the American Thoracic Society that gives stars to physician groups and hospitals based on how many patients die during surgery and/or have serious complications after surgery; whether or not the surgeons use the type of valve shown to have the best outcomes; and whether patients receive the appropriate medications before and after surgery. The Society has another database with similar information on percutaneous coronary interventions like angioplasty and stents.
I also urge you to always ask the following questions before agreeing to any test or procedure:
- Why are you recommending this?
- How will this test change your treatment decision or my diagnosis?
- How often have you performed this procedure?
- What are the risks and benefits?
- What is your mortality rate when performing this procedure?
- What percentage of your patients develop a complication and/or are readmitted to the hospital within 30 days of discharge?
Finally, always get a second opinion about any serious diagnosis or recommended procedure.
It’s time we started shopping for health care the same way we shop for cars.