More care is not necessarily better care

On June 1st, I received a call that my mother needed emergency triple-bypass surgery the next morning. Her doctors presented a very grave picture. She needed the surgery or she may have a fatal heart attack as soon as that night. The family flew in to Charlotte NC to be with her during the surgery and then back again to help with her discharge to home.

This personal experience raised many issues and frustrations regarding her medical care:

First, there is such limited information on the quality of doctors. There was decent data to show that the hospital was well-regarded for cardiology. However, our family wanted to know who was doing the surgery and were they good and experienced at it. I was quite disappointed with the only data I could find from one of the largest commercial quality data vendors, HealthGrades. Their data basically told me the doctor’s education and training, board certifications, languages, and disciplinary actions. The data was not very helpful at all. Consumers need better information and public reporting of physician quality information, particularly as the country is moving towards consumer-driven healthcare. MedPharma has been working with Mass Health Quality Partners which is “educating the public about health care quality, including appropriate public release of performance information, supports quality improvement and enhances public accountability.” MHQP is one of a few leading organizations in the country really pushing a quality agenda in the mainstream. Much of the work to date nationwide has been around primary care, and some of the greatest needs are in specialty care. This work has been largely left to the specialty medical societies such as the American College of Cardiology to define and gain consensus on appropriate specialty quality measures.

Second, there was no discussion of alternative treatment options. The information was presented by the doctors in such a stark, one-sided manner. I enjoyed reading the July 7th 2005 Business Week article entitled Is Heart Surgery Worth It?. With over 400,000 bypass surgeries and 1 million angioplasties a year, the article estimates the heart-surgery industry to be worth a $100 billion a year.

“More and more doctors are questioning whether such heart procedures are actually extending patients’ lives. One of them, Dr. Nortin M. Hadler, professor of medicine at the University of North Carolina at Chapel Hill and author of The Last Well Person, is urging the U.S. medical establishment to rethink its most basic precepts of cardiovascular care. Bypass surgery in particular, he says, ‘should have been relegated to the archives 15 years ago.’ … The data from clinical trials are clear: Except in a minority of patients with severe disease, bypass operations don’t prolong life or prevent future heart attacks”

I find this to be quite shocking and sad. It’s been eight weeks since the surgery, and my mother is still quite weak and recovering, just now able to start her cardiac rehab. We were pleased with both her doctor and hospital. I agree with the article that patients should decide for themselves and need the appropriate information about all the risks and benefits as well as the alternatives such as medicine, diet, and exercise. The main question that lingers in my mind is “was it really necessary?”

July 21, 2005

One thought on “More care is not necessarily better care”

  1. .
    First, glad to hear that your mother’s recovering, and that she didn’t suffer the potential heart attack.

    Second, I couldn’t agree more with your assessment of the (sad) state of information about the quality of care. I’ve read about, and blogged on, the trend toward “transparency” in the cost of care, but seen precious little improvement in the availability of quality of care information.

    As you noted, with the drive toward CDHC, we need that
    “quality” info just as much as the cost info.

    Good post.

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