ranking doctors and quarterbacks

Monday, October 20, 2014

Once upon a time, sports pages reported about the game. Analysis was more than just the numbers. Reporters and columnists wrote about the ebb and flow of the action, along with the turning points that might had led to that one defining moment where victory or defeat was defined. And then came fantasy football. Instead of team, the focus changed to individual player statistics and who won the game was of secondary importance. Welcome to the same reality that has inched itself into grading doctors and hospitals.

Sometimes statistics are helpful in deciding the quality of care provided to a patient and sometimes those numbers can be deceiving. The latest version of www.healthgrades.com went live this week and it advises that there is a “right way to find the right doctor.” And their philosophy and advice is absolutely correct. Being able to assess a physician’s experience, patient satisfaction and the hospital quality all will give guidance, but too often that guidance presumes a level playing field and that is not always the case. Ratings need to be taken with a grain of salt because context is everything.

This week in the NFL, the Panther’s Derek Anderson and the 49ers Blaine Gabbert placed in the top half of quarterback rankings. Both are backups who came into the game after the outcome had been decided. Johnny Hekker of ranked #7 this week for his one pass completion on a fake punt. However, the cream does rise to the top, as Peyton Manning and Aaron Rogers ranked #1 and #2 for the week, but not every team gets to have a superstar.

In medicine, it’s all about context. Hospitals are not necessarily equipped to care for every medical situation. Some have developed programs with special expertise in trauma, heart attack or stroke. Fewer can care for major burn victims or can perform organ transplants. Hospitals are ranked on patient outcomes and many have to do with complications that might occur during or after a patient hospitalization. Post-operative infections, blood clots, wound healing problems and bed sores are a few parameters that are monitored. The problem with blindly comparing hospital data has to do with patient distribution. Some hospitals are not equipped to care for the sickest, most complicated patients and when they present to their doorstep, the patients are transferred to hospitals that have the capability to provide them care. This is the right thing to do for the patient but the sickest patients also have the highest complication rates, even with the best of care.

Similarly, some physicians and their nursing teams take on the most challenging patients, knowing that some are destined to have reportable complications. Patients with diabetes and patients who smoke have high rates of wound infections and may not heal properly. The risk/benefit analysis for some patients skews to the risk side and yet, sometimes, operations are potentially unavoidable because the alternative is death.

Mayo Clinic in Rochester is a world renowned center of medical excellence. Two hospitals care for their patients. Healthgrades has ranked St. Mary’s Hospital with 34 five-star rankings and 15 five-star awards. Methodist, its sister hospital has but 14 five-star rankings and 9 five-star awards. St. Mary’s has worse than average complication rates for a few of the monitored surgical complications while Methodist is ranked above average. With the same physician and nursing staff, it is likely that one hospital is geared to care for the most injured and ill and is to be expected that their complication rate will be higher. The same type of dichotomy is also found at Massachusetts General Hospital in Boston, the flagship for Harvard Medical School, highly ranked and awarded and yet with worse than expected complication rates.

When it comes to patient satisfaction, only in Lake Wobegon can all the physicians be above average. There are times when the physician must answer “no” to a patient or family demand. Having a less than satisfactory interaction with the patient, may cause a Healthgrades rating to decline, regardless of the soundness of the medical decision making.

The question then remains: how should one find a doctor or choose a hospital? It starts with asking people you know and trust.

  • Family and friends are the first resource to recommend a doctor that they trust.
  • Next comes the hard work. Your doctor should be board certified in their specialty, meaning that they have not only graduated medical school, but also completed post graduate training and have passed their exams. http://certificationmatters.org/
  • Now it’s time to check whether any red flags for discipline or malpractice are flying. A very useful link from Consumer Reports

Once the preliminary screening is done, it’s time to decide whether you like that doctor as a person and to see whether you are compatible. You should feel comfortable not only with the science, but also with the communication skills. Bedside manner is important in increasing the likelihood that a patient will follow their doctor’s advice.

And finally make a plan for emergencies. For some, there may be only one hospital in town, but in larger cities, numerous hospitals vie for your business. Knowing which hospital is best for stroke emergencies or heart attack or trauma may be life-saving. Paramedics and EMTs know and are trained to take the patient to the proper facility, even if it means bypassing a hospital that is closer. But when it’s family that’s driving, you need to know where to go.

Statistics are more than looking at the raw numbers. Understanding how a doctor or hospital ranks is sometimes no different than the process needed to understand quarterbacks and wide receivers. No disrespect meant, but Blaine Gabbert may not be a better quarterback than Joe Flacco or Russell Wilson, regardless of what the numbers say.

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