How to Get Accurately Diagnosed and Get the Best Treatment
Short answer: Pick the right hospital. Use this essential checklist to help.
The differences in the care you receive at different hospitals can be shocking. Do not underestimate the importance of choosing the right hospital if you want to stay safe and find the fastest path back to health.
Two patients walk into two different hospitals. Each has an identical cancerous tumor in their abdomen.
The first patient goes to a hospital that is a center of excellence for cancer, as designated by the National Cancer Institute. This patient has laparoscopic surgery after a tumor board of multi-disciplinary physicians agrees it’s the best approach. During the surgery, something unexpected happens, but the surgical team has done so many of this type of surgery that the nurse hands the doctor the tool she needs even before she asks. The surgery goes off with out a hitch. The patient leaves with two bandaids.
The second patient heads into a hospital that has a department called a “cancer center” and displays an award it received from a magazine. After a long diagnostic delay, this patient is operated on by a surgeon who isn’t a specialist in this type of tumor. He doesn’t know any better so he performs an open surgery resulting in a long incision with lots of stitches and staples. Something unexpected happens but no one notices until the patient develops an infection a week later. This requires a second surgery. The patient endures over a year of costly problems, both medical and financial. Some she will never recover from.
I could have used a cardiac surgery example where mortality rates at different hospitals for similar procedures can vary from 1 in 6 patients dying at some hospitals to less than 1 in a 100 dying at others. Other terrifying data points can be found for joint replacements and spinal surgeries, hysterectomies, giving birth … basically anything that is serious and/or requires getting cut open.
Don’t make the same mistake many do: They choose a hospital to treat a more serious condition because they already have a physician there from before. Or maybe because their kids were born there, or they had a friend who knew someone who went there. Or maybe its just the most convenient place.
These are all frankly terrible selection criteria. Do your research. You or a loved one’s life could be at stake.
Want more compelling data on this? Here’s an infographic showing that your risk of dying varies wildly depending on which hospital you choose: https://bit.ly/2VqAMM7
And here’s a short horrifying video by USA Today about how low-rated US hospitals are deadlier due to mistakes, botched surgery & infections: https://www.usatoday.com/story/news/health/2019/05/15/patient-safety-d-and-f-hospitals-have-twice-death-risk-error/1183705001/
Here’s the essential short list of six must-do’s when you are faced with choosing a hospital for yourself or a loved one:
#1: You want to go to a hospital that does a lot of whatever you need done. The volume differential matters, especially for major conditions and rare conditions. Find the hospital that sees the most patients like you.
Check out the American Hospital Directory for self-reported cost and quality information. Look for the specialty you need in the chart.
- No matter what condition you have, make sure the patient numbers are high compared to other hospitals you are considering.
Another way to go is low-tech sleuthing. Look for:
- A floor or unit for only the condition you have or type of surgery you are having. For instance, for back surgery, do they have a floor or unit that is used only for spinal surgeries? Is there one department for all oncology patients (bad), or does each tumor type have its own area or floor?
- Operating rooms that are used only for your type of surgery.
- Pre-printed patient materials specifically for your condition or type of surgery.
- A team of physicians who work together on your condition or type of surgery, or at a minimum a number of physicians who do the same thing.
- Look online for the amount of research being done by that hospital in your specific disease area and/or how many clinical trials are going on there.
Pro Tip: You want a hospital that has a team of qualified physicians and nurses working together to help patients like you. Multi-disciplinary professionals who consult with each another will always outperform one solo physician or surgeon, no matter how star-studded.
- Ask your physician if any of their colleagues have weighed in on your case. If your doctor looks at you with a confused expression, he or she is flying solo.
#2: Check out the quality scores of hospitals you are considering. Don’t forget that infections and medical errors kill more surgical patients than knives do.
- medicare.gov/hospitalcompare — Performance scores based on Medicare data and patient experience surveys
- Check if your hospital has been penalized by Medicare: https://khn.org/news/hospital-penalties/readmissions/
- The Commonwealth Fund
- The Joint Commission Data from the group that inspects and accredits most U.S. hospitals.
- The Leapfrog Group k on patient safety and the safety of selected procedures (This data is self-reported and not entirely reliable. Just saying.)
- Consider subscribing to Consumer Reports. You need a subscription to see the rankings: https://www.consumerreports.org/hospitals/HowToChooseAHospital/
- For cancer, make sure your hospital is on this list: https://www.cancer.gov/research/nci-role/cancer-centers/find. Also read this article for further insight: https://glennsabin.com/deceptive-marketing-in-precision-cancer-care/
- For cardiac procedures check with the Society of Thoracic Surgeons to see if the hospital you are considering has a good score. If the hospital isn’t listed at all, that’s probably bad news. I’d go somewhere else: https://publicreporting.sts.org/
#3: Look up your surgeon or physician:
- healthgrades.com : Scroll down until you find the “procedures or condition” section. At a minimum, you want a doctor who has your condition listed here. Beyond that, you want a doctor to be in the top percentile of physicians for this procedure or condition.
BTW — if you see “cancer” like in the middle above, that’s not good enough. If you have bile duct cancer, find a doctor with “bile duct cancer” in their profile. If you have multiple myeloma, find that doctor. Knowing a physician sees “cancer” patients is like the Yankees scouting someone they heard “might be good at sports.”
- You can check out Health Grades, Yelp, ZocDoc or other sites for patient satisfaction scores. Keep in mind that bedside manner is most important if you need someone to diagnose you or help you find the right nuanced treatment plan. For a surgeon, the best ones might not be the kindest, most gentle ones.
#4: Ask the right questions (From Marty Makary with a few of my own additions):
- How many of this exact kind of surgery do you do every year? OR How many patients have you seen who have this exact condition?
- Are there other surgeons/physicians you sometimes refer patients to if the surgery or situation is unique in some way? (This one checks whether the surgeon operates on everyone himself or herself, regardless of his or her skill level at that particular surgery. You want to trust you’ll get a referral if the doctor isn’t good at what you need.)
- Are there other ways of treating this?
- What percent of these operations are done open versus the minimally invasive way in the U.S.? What percent of these operations do you do open versus the minimally invasive way?
- What are the differences in complication rates for each possible treatment option?
- How many days will I be in the hospital if I have it done one way versus the other?
- Can I get a second opinion while I’m here in the hospital?
Nurses are the ones who know better than anyone if a physician and hospital is good. A “no” or wishy-washy answer to any one of these questions should send your antenna sky high. Questions to ask a nurse or two:
- Is management here responsive when someone brings up a safety concern? Do you feel comfortable speaking up when you have a safety concern?
- Would you feel comfortable having your own care performed here?
- Which doctor treats the most patients like me?
- Which doctor would you go to if you had my condition?
#5 If the hospital or physician/surgeon you choose first turns out not to make the grade, go somewhere else. It might be inconvenient to start over, but it’s far more inconvenient to do so after your body was harmed unnecessarily and you have a mountain of medical bills.
#6 Never, ever get a surgery or remain too long in pain without getting a second opinion. More than 20% of diagnoses are wrong in this country and 77% of treatment plans change with a second opinion from a more qualified physician.
I hope this helps you and please be safe out there!
*the short stack of books I’d recommend for further reading:
Mistreated: Why We Think We’re Getting Good Health Careand Why We’re Usually Wrong by Dr. Robert Pearl
You could also listen to my podcast with Dr. Pearl: https://relentlesshealthvalue.com/audios/ep176/
