Entries for March 2008

I've spent an hour or so browsing the overhauled Hospital Compare page (which went live today at 3 p.m.) and its patient satisfaction data.

• You may be frustrated if you search by hospital rather than by city or by a particular condition or procedure. I found that the name of the hospital has to be typed exactly right, including even hyphens, or nothing will come up.

Patient satisfaction surveys have been on consumer advocates' wish list for more than 10 years—and at 3 p.m. today their wish was finally granted. The federal government's Hospital Compare page has added a massive amount of information about 2,521 hospitals that reveals how often (never, sometimes, usually, or always) and how well patients' various needs were met: nurses listened to them, doctors treated them with courtesy and respect, their pain was kept in check, and in 19 other ways they were recognized as individuals. The survey is called HCAHPS (read as H-caps), for Hospital Consumer Assessment of Healthcare Providers and Systems. "A long acronym for a simple concept," said Rich Umbdenstock, president of the American Hospital Association, at a press briefing this morning. "It will be the same as getting answers from hundreds of friends and family members" about a hospital.

Interesting question: Is there a relationship between the quality of patient care that a hospital delivers and the hospital's degree of participation in clinical trials? Maybe so, suggests a new study in the Archives of Internal Medicine.

The study looked at 174,000 patients with serious heart problems. All were admitted between 2001 and mid-2006 to one of 494 U.S. hospitals that had agreed to monitor their care to see how faithfully they were given four drugs (such as aspirin and beta-blockers) within the first 24 hours and five (such as a statin) prior to discharge. To be monitored, patients had to be enrolled in the initiative. Only 2.6 percent of the patients agreed (few clinical trials boast high enrollment rates). Some hospitals signed up a fair number of patients. Others didn't enroll a single one.

Like my colleague Michelle Andrews, I've been following the proliferation of doctor-rating sites. And like her, I can see theoretical value in them. They could be a good tool when seeking a primary-care physician—someone who should have good people skills besides a solid base of medical know-how: the ability to listen between the lines, to say, "I don't know," to look at his patients and truly see them.

I'm bothered, however, by the viral spread of these sites and by how thin and potentially misleading they are. Yes, Web users know at some level that what they read about a doctor hasn't been carefully vetted. Do they mentally apply a correction factor when they read a post flaming (or overpraising) a doctor? Maybe they do. But it's hard. How do you put words on the screen into perspective when you don't have any? And it's so easy to take swipes on an anonymous website. It's no news that our online personalities are different, and not necessarily for the better.

After a week spent touring hospitals in India and Singapore, during which I made a point of talking with patients without hospital officials hovering nearby, I have come home with two strong impressions. One is of an extremely high level of care. The other is of an equally high degree of caring.

Every patient, most of them American, spoke gratefully but disbelievingly about how often their doctors visited them before and after surgery, and about their kindness and concern. It seemed as if hardly an hour would pass, they told me, without the surgeon or another physician taking a few minutes to drop by, chat for a bit, and make the human connection that patients ache to receive.

Here's something you don't read every day from a reviewer. After he looked over a recent study in Urology, pediatric urologist Bradley Kropp of the University of Oklahoma Health Sciences Center had this comment: "In today's high-tech, molecular-driven scientific world, it is nice to come across an article that can be implemented immediately into our practices without increased healthcare cost." The subject was gum. Specifically, a pack a day for postsurgical patients. Chewing a piece every few hours, according to the study, stimulates the intestinal tract to start working again after surgery.

Patients who have had major abdominal surgery—a urological example would be removal of a cancerous bladder, or cystectomy—know all too well that immediately afterward, the digestive tract slows or shuts down completely. The goal is to restore normal function quickly, to prevent blockages, swelling, and pain (and allow patients to return to normal food). In the study, conducted among 102 patients at the University of North Carolina by Raj Pruthi and others, 51 patients who had had a cystectomy chomped a piece of Wrigley's Freedent every two to four hours, starting the day after surgery. Compared with 51 similar but Freedentless patients, the gum chewers' intestines started working about half a day earlier.