Tuesday, February 14, 2012
Are Teaching Hospitals Safe?
I spent the bulk of my career working in teaching hospitals
affiliated with medical schools. During
that time it was commonly understood that those were the hospitals to which you
went to get the best care. With their
highly specialized medical faculties, their research programs, their flocks of
students and trainees, and the latest equipment and technology, that seemed to
be a reasonable assumption.
As the years went by, I began to have some doubts. I remained convinced that it remained true for
the rare or very complex cases that drew the interest of the faculty but for
the other cases, who constituted the vast majority, I wasn’t so sure the care
was all that good. After all, most of
the medical work was being done by residents and students who were not yet
full-fledged doctors. And it seemed to
me that the faculty members weren’t paying all that much attention to the daily
routines of care, being more concerned with the research projects, published
papers and visiting lectureships that would promote their careers.
I also had occasion from time to time to be exposed to some
small community hospitals where the care seemed to be to be quite good and
where the governing board took an active interest in the performance of the
clinical staff.
All of this led me to the prediction that when the day came
that quality was being measured and reported, there were going to be some big
surprises. Places that few had heard of
might well turn out to have better numbers than the big and famous ones.
Now it seems that I may have been right. Page 6 of the February 13 issue of The Boston
Globe carried a story reporting that according to Medicare, “teaching hospitals
were about 10 times as likely as other hospitals to have high complication
rates.” Out of 3300 hospitals reviewed,
190 were reported to have very high complication rates and 82 of these were
teaching hospitals.
Predictably, teaching hospitals pooh-poohed the results,
saying that the methodology was faulty and didn’t properly take into account
the larger portion of complex cases they treated.
No doubt the methodology is less than perfect, but you can
be sure that whoever in Medicare decided to issue the numbers knew what the
response would be but thought the data was good enough to warrant
publication. I suspect they were right.