Entries for July 2007

Q: What's the difference between a tired doctor and a drunk? A: If you're the doctor's patient, not much. A fatigued physician and someone who's legally drunk both think, focus, and perform skilled work at about the same level, according to the American Medical Student Association. Nurses might not be different, as one of them recently reminded me in her post on an Internet site devoted to discussions about patient safety (listserv: patientsafety-l@LISTSERV.NPSF.ORG).

I never get used to it, no matter how often it happens. Somebody tells me he needs surgery. I suggest asking the surgeon how many times she's done the procedure. "Really?" he says, clearly surprised. "You can ask a doctor to give you numbers?" No matter what kind of surgery or whether the setting is a hospital, an outpatient clinic, or a doctor's office, the principle is no different for surgeons than for musicians or tennis players: Practice counts. If it didn't, we'd have medical students do the surgery when the veteran cutters are out of town. They'd charge less, too.

Before setting the how and why of the Best Hospitals rankings aside for a while, I'd like to set the record straight on a final couple of points. One reader informed us that he knows that if an M.D. is one of the specialists we survey every year to get the names of up to five hospitals they consider best in their particular specialty, he can make sure his own hospital is ranked simply by writing in its name "even if it is not a very good hospital at all."

How good is your local hospital at hand-washing? Administrators might—or might not—be tracking how faithfully their doctors, nurses, and other caregivers disinfect their hands with soap and water or an alcohol gel before touching patients. Either way, just try asking for this information. Good luck. How about the frequency of patient falls? Good luck again.

Every year's release of the Best Hospitals rankings brings me an earful (or screenful or sometimes even an actual letterful) from patients or their families or friends who want to vent. This year is no different. Some complain that we left out a wonderful, caring, lifesaving hospital. More typically, they are upset because a certain hospital got in. They tell tales of breathtaking callousness—appointments to see a dying child repeatedly broken at one prominent hospital; a rude, arrogant physician at another high-ranked facility who ordered a woman and her ill mother off the premises.

Making patient safety one of the elements of the Best Hospitals methodology has been a goal for us and our resourceful and skilled contractor, RTI International, for several years. We're working on it and getting closer. But whatever data go into the mix have to meet reasonable standards, and so far the existing safety data are ungettable or skimpy. Or they fail the "face validity" test, as statisticians put it, meaning that if you give the numbers a common-sense once-over, they fall apart.

Another query I get time and again, most recently this morning, is why we don't rank hospital emergency departments. Funny, I don't recall anyone asking except emergency physicians, but it's a fair question—especially at a time when these departments are expected to deal immediately and capably with outbreaks of infectious disease and the aftermath of natural disasters and terrorist attacks, in addition to the usual gunshot wounds, car-crash victims, feverish babies, and accidental poisonings.

With the new Best Hospitals rankings online now (health.usnews.com/besthospitals) and out this coming Monday in U.S. News, the magazine, I thought I'd devote a few posts to a few of the more interesting questions that get tossed at me each time the annual guide appears.

The one I probably get most often is why we don't take patient opinion into account. Well, that would be nice. I'd like very much to do that. But how?

Gee, what a nice present. With this year's Best Hospitals rankings due to come out in less than a week, our annual exercise has just received an endorsement of sorts from one of the American Medical Association's most widely read journals, the Archives of Internal Medicine. In a study appearing today, a team of researchers based at the Yale University School of Medicine concluded that heart-attack patients who went to the 50 hospitals that U.S. News ranked tops in cardiology and cardiac surgery in 2003 had death rates about 11 percent lower than similar patients at nonranked hospitals did.