Are Good Doctors Bad for Your Health?

[xoxoxoBruce]

An article in the New York Times, by Ezekiel J. Emanuel, an oncologist and a vice provost at the University of Pennsylvania.

PRETTY regularly, I receive an urgent call from a distraught friend or friend of a brother. “Zeke, Mom was at home and her heart stopped. The E.M.T.s are rushing her to XYZ hospital in Miami. Can you help me find the best cardiologist there for her?”

“Get me the best cardiologist” is our natural response to any heart problem. Unfortunately, it is probably wrong. Surprisingly, the right question is almost its exact opposite: At which hospital are all the famous, senior cardiologists away?

One of the more surprising — and genuinely scary — research papers published recently appeared in JAMA Internal Medicine. It examined 10 years of data involving tens of thousands of hospital admissions. It found that patients with acute, life-threatening cardiac conditions did better when the senior cardiologists were out of town. And this was at the best hospitals in the United States, our academic teaching hospitals. As the article concludes, high-risk patients with heart failure and cardiac arrest, hospitalized in teaching hospitals, had lower 30-day mortality when cardiologists were away from the hospital attending national cardiology meetings. And the differences were not trivial — mortality decreased by about a third for some patients when those top doctors were away.

[orthodoc]

The younger house staff (residents and fellows) got to do their thing without interference or politics.

[xoxoxoBruce]

Yes,

the junior physicians — recently out of training — may actually be more adept clinically.

I sent the link to this article to my cardiologist, who incidentally is part of the Penn system, and probably knows this guy. I'm curious to see if I get any feedback... or pushback, from her, since less than a month ago we argued about reducing medications.

I keep thinking about my buddy's father who at 45, through bad diet and good living, developed very high blood pressure and cholesterol levels. They put him on meds and told him to change his lifestyle which he did. Well, his wife had a large hand in him cleaning up his act. But every time he went back to the doctors they said he was doing fine and didn't change his meds. Those meds put him on dialysis after 15 years without letup. The doctor said, oops.