Magazine's hospital rankings not the whole story

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An orderly opened a pack of gauze and told the patient to roll over.

The startled gentleman asked, “What are you doing to me?”

“What your doctor ordered. Roll over. “The patient was my father, a fireman who didn’t question the wisdom or good intentions of a physician. He bit his lip while a wad of packing — well it went where he didn’t need it. The man in the next bed snickered. He had hemorrhoids removed that afternoon.

Medical errors are seldom so humorous.

The August 2012 issue of Consumer Reports caught my attention with the following statement:

“Medical harm is probably one of the three leading causes of death.”

A report of the Department of Health and Human Services states that infections, surgical errors and medical mistakes contribute to 180,000 deaths and 1.4 million injuries per year. Many of those are preventable. The purpose of reviewing this article is meant to reduce the chance that you end up on that list.

Consumer Reports based its conclusions about hospital safety on government data (hospitalcompare.hhs.gov) and another system developed by some of the county’s top experts. An industry group paid the tab for leapfroggroup.org.

I did what you might do when I saw the numbers. I flipped to the back page to see how our Walla Walla hospitals ranked. They weren’t listed, although Kadlec hospital was near the top in the United States. Kadlec’s achievement warrants congratulations, but the issue for a patient in Walla Walla becomes whether they should have a hip, a knee or an eye operated on in a hospital that’s down the street, say, on Poplar or Second. How does someone like you, the reader, make a smart decision?

Look beyond the bold print.

Hospitals report data to the government. Forget politics. Forget suspicions about science. Is the system tainted by financial incentives or personal relationships? I don’t see anything disturbing in this particular program, and I’ve watched what lobbying accomplishes.

I pressed to get funding for research programs and fought to eliminate cigarettes from airplanes. I’ve seen Congress reach into offices where its fingers didn’t belong. As far as I can tell, this system looks clean.

Some rating programs come from groups that want to make their members look good. Others receive their income from the institutions they rate. Sound like the banking system or an imperfection human misbehavior?

The ranking by Leapfrog is a different story. Industry leaders chose bona fide experts to assess the hospitals where business paid for services. The team set a list of criteria for important practices that appear to predict outcomes. That’s an intelligent approach. It can never be perfect.

I went to both local hospitals and spoke with their public information directors.

At Providence St. Mary Medical Center, I was linked with Dr. Michael Bernstein. We talked about rankings and the attempt in both hospitals to minimize risks to their patients.

He made no attempt to argue that we had no problems in American medicine. He saw things as getting better and he was willing to share data. The reason Walla Walla hospitals aren’t listed by Consumer Reports relates to the use of the Leapfrog system.

One criterion Leapfrog uses is heavy physician staffing in the emergency room. Its requirements exceed the budget of most hospitals. As a result, only a small percentage of all U.S. institutions sign up. A program that lists less than 25 percent of hospitals has limited value.

If we look at the outcome information available from reports to the government, both Walla Walla hospitals compare well.

I determined that systems of evaluation, especially online rankings of doctors and hospitals should raise questions, but they are still evolving as reliable resources. Some are deceptive. Pick a doctor and a hospital that will discuss the number of cases they do and what problems they’ve experienced.

Those are fair questions and deserve honest answers. Find a personal physician, if you can (that’s a place where institutions could spend more and organize better).

Trust is important and your primary provider should help guide you. Ask a couple of former patients who had similar procedures. I’ve had procedures done in Walla Walla and one performed at the university, when I worked there.

I like my doctor and the comfort of being able to talk with her and the surgeon who is going to open me up and probe my innards. Realize that some caregivers are simply better at what they do, and the best ones don’t all want to live in a big city.

Finally, if anyone tells you to roll over and do what the doctor ordered, it may not be too late to run.

Dr. Larry Mulkerin is a retired clinical professor. He can be reached at mulkerin@charter.net.

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