The Best Hospitals
An exclusive survey of more than 1,000 leading doctors yields 43 sources of top medical care
RESOURCES
American Diabetes Association (see the white pages). Pamphlets, fact sheets, answers to individual questions. American Thyroid Association, (800) 542-6687. Pamphlets and referrals to board-certified endocrinologists. National Osteoporosis Foundation, (800) 223-9994. Free 22-page booklet on osteoporosis.
GASTROENTEROLOGY MAYO CLINIC ROCHESTER, MINN. / 42 pct.
MASSACHUSETTS GENERAL HOSPITAL BOSTON / 35 pct.
CLEVELAND CLINIC / 31 pct.
JOHNS HOPKINS HOSPITAL BALTIMORE / 24 pct.
UCLA MEDICAL CENTER LOS ANGELES / 20 pct.
MOUNT SINAI MEDICAL CENTER NEW YORK / 20 pct.
Gastroenterology departments treat digestive disorders from routine heartburn and abdominal pain to ulcers, liver disease and cancer. Endoscopic ultrasound--organ scans from inside the body using sound waves--has boosted cancer screening effectiveness, and new drugs that suppress the immune system have turned liver transplants into reliable lifesavers.
EXPERT'S VIEW
MICHAEL SIVAK, chairman, department of gastroenterology, Cleveland Clinic: Gastroenterology has become so complex that it is subspecialized, and any really good department is involved in training these subspecialists. We have gastroenterologists training in endoscopy and liver disease, for example. There are many good hospitals without training programs, but I think training reveals a certain dedication. Some people are put off by an attending physician who is in training. But the trainee is already certified in internal medicine. The level of skill of the trainees coming through now is so high that there's no way they can get away without knowing what they're doing. The best institutions also do research and publish the results. That reveals two things: the hospital's particular area of interest and physicians who are constantly questioning, looking for better treatment. Also, gastroenterology is more and more technology oriented, and ongoing research reveals a dedication to stay at the forefront of technology.
RESOURCES
National Digestive Diseases Information Clearinghouse, Box NDDIC/USN, 9000 Rockville Pike, Bethesda, MD 20892. American Liver Foundation. Patient information and referrals, (800) 223-0179. "Gut Reactions," by W. Grant Thompson, M.D. ($22.95, 1989, Plenum Press). A lay-language discussion of digestive disorders.
GERIATRICS UCLA MEDICAL CENTER LOS ANGELES / 22 pct.
BETH ISRAEL HOSPITAL BOSTON / 21 pct.
DUKE UNIVERSITY MEDICAL CENTER DURHAM, N.C. / 18 pct.
MOUNT SINAI MEDICAL CENTER NEW YORK / 16 pct.
MASSACHUSETTS GENERAL HOSPITAL BOSTON / 14 pct.
JOHNS HOPKINS HOSPITAL BALTIMORE / 10 pct.
Geriatrics departments or programs are staffed by internists trained to diagnose and treat the many diseases and disorders of old age. Typical patients are in their 80s and are being treated for four or more conditions, including such problems as heart disease, arthritis, Alzheimer's or disabilities due to stroke. Geriatric programs also provide social and psychological services.
EXPERT'S VIEW
ROBERT BUTLER, chief of geriatrics, Mount Sinai Medical Center: Older patients who are being treated for, say, heart disease, diabetes and arthritis and worry that their care is not really integrated should look for geriatrics programs that offer comprehensive assessments, which can be done on an outpatient basis. Often we spot undiagnosed underlying conditions. That's because disease affects older people differently than it does other patients. An overactive thyroid may not cause the usual metabolic symptoms; a heart attack may cause confusion, not chest pain. Because we have the expertise to provide the primary care for all of our patients' medical problems, there is better coordination of care. In prescribing medications, for instance, we guard against drug interactions. And we can help patients overcome social and psychological problems as well by bringing them together with home-health aides, social workers and psychologists. We also help patients understand what we're doing when technical procedures are involved.
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