The treatment which has been proven over the past years for heart attack, pneumonia, and congestive heart failure is NOT being given to many patients in the United States.
The treatments are now standard. They have been agreed upon over decades as life saving procedures for patients suffering these serious ailments which are often (or, in the case of congestive heart failure, normally life-threatening). There is an article this week in the New England Journal of Medicine showing that are the norm in most medical practice and are not being used for the patients appropriate for them.
The Detroit News recently reported that:
” Reviewing data from the Centers for Medicare and Medicaid Services on 10 indicators for quality of care at 3,558 hospitals in the first half of 2004, researchers at Harvard School of Public Health found that simple, universally accepted treatments were not provided for:
• 11 percent of heart attack patients.
• 19 percent of those with congestive heart failure.
• 29 percent of pneumonia sufferers.”
There is a problem in modern medical practice (more than one, actually). While there are “evidence based guidelines” for these most serious afflictions and conditions, it is not always possible to get 100% of the practicing physicians to follow them.
Another member of the accreditation group was quoted as saying, “The studies illustrate a problem in modern medicine. While there’s a growing list of scientifically supported protocols for specific conditions called “evidence-based medicine,” physicians and hospitals don’t always follow them.
Making the shift requires creating evidence-based guidelines, getting hospitals and doctors to accept they’re the right thing to do, agreeing how to measure results, and finding processes to make sure they happen, Loeb said.
Those processes are likely to involve financial incentives, he said. “As much as we like to think of medicine as an altruistic profession, green seems to be the color of the (needed) elixir.”
There are a number of factors, however, in the quality of hospital care. Each hospital tends to have specialties and is probably far better in, say, cardiology than traumatology. As a matter of fact there are only a limited number of real trauma centers rather than just emergency rooms. The Ryder Trauma Center in Miami is the regional trauma center and sees horrendous cases on a regular basis. The helicopters land on the roof and the fire department rescue/life support trucks line up on normal days.
There was also a study some years ago that found that cardiac units were best where the most surgery was regularly done. Your survival chances were higher where the cardiologists and thoracic surgeons did it most often. I have managed to survive CHF 11 years so far (they originally predicted 3-5 with luck) by going to the CardioVascular Institute of Baptist Hospital in Miami where the medical director of the unit plays in my arteries and Efrain Gonzalez, an electrophysiologist, installs and monitors a sophisticated computer he buried in my chest with wires (I suspect they were red and black and from Radio Shack) that snake into the chambers of the heart. Amazing things are being done in those places where things are done right.
The crux of the problem is usually that this is a choice you or someone else has to make during the stressful time of illness or accident. It is also the choice made for simple procedures that poor care and mistakes can turn into fatal errors. Andy Warhol went to one of the “best” hospitals in New York City for a simple gall bladder operation and came out on a slab. In Tampa some years ago a man who went in to the hospital for the amputation of a diseased foot. They did it well except they removed the good one. These “accidents” are not unusual. They are kept quiet in a profession that polices itself and protects its own.
So, when it is time to plan or hurriedly enter a hospital, how do you decide which hospital is best, safest and most effective for that which ails you? To find the Cardio Vascular Institute of Baptist Hospital in Miami from my home in Mexico when my cardiologist in Mexico had hugged me, cried and said, ” I hope to see you again”; I used the internet and guessed based on services, philosophy, pictures, an international services department and hope. That time I was right.
Here are links to some sites that may be able to help and there are Amazon links at the bottom of the article.
The best I could find is US News and World Report’s, “America’s Best Hospitals” at JCHA.
The Joint Commission on Hospital Accreditation has a site that is certainly interesting but complex and almost unusable at Joint Committee.
A site that helps rate hospitals and pick practiioners but is rather commercial at Health Grades might be of use.
The US Department of Health and Human Resources has a site that seems simple but is lengthy and complex compating treatments for pneumonia, heart attack and congestive heart failure at .
Then there is the necessity of treating urgent things at the nearest decent place and also discussing it with physicians, friends, heath care workers…
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