For Major Medical Problems, Memorize This Mantra

Practice makes perfect (THINKSTOCK)

Practice makes perfect (THINKSTOCK)

Rural hospitals are doing more and more surgeries—and that’s not always a good thing, according to a story in The Wall Street Journal. In my 30 years of helping people get the best medical outcomes, I’ve seen what a difference it can make when patients go to major medical institutions—and when they don’t.

One day, I got a call from a man whose mother had developed esophageal cancer, and he had mistakenly sent her to her local community hospital for surgery. He was a smart guy, who loved his mother dearly, yet it never occurred to him that she was likely to get better care at a major medical institution. In fact, he passed an excellent hospital on his commute to the city, six days a week. But he probably thought mom would be more comfortable being close to home.

Community hospitals are terrific institutions that do great things, but this woman’s surgery was very technical, complex, and risky. And, sadly, there was a complication—a mucus plug clogged her esophagus. Presumably, in a larger institution, the medical staff would have detected it and managed it quickly—because it’s not uncommon. But hers was missed and her brain was deprived of oxygen for too long. She suffered irreversible brain damage.

It never has to be this way. Here’s a Patient’s Playbook mantra that I want you to memorize:

For significant problems, go to significant institutions.

We all know that, in life, experience matters and practice makes perfect. Professional musicians put in thousands of hours of practice on their instruments before they get really good. Great athletes practice plays over and over again. And the same is true for medicine. Great surgeons must hone and refine their skills through practice. Top specialists gain expertise through years of hard and focused work. And hospitals are better prepared to care for you and anticipate any complications when they have already overseen hundreds, perhaps thousands, of cases just likes yours. 

When we talk about this in medical terms, we often talk about volumes. For example, you really want to know:

How many times has your surgeon performed your EXACT procedure?
How often has your hospital treated patients with your EXACT disease?

Volume becomes critically important when you need a complex operation—things like heart and aneurysm surgeries, cancer surgery, brain surgery, endocrine surgery, etc. Or, if you have multiple conditions that require vigilant monitoring, as well as weighing the pros and cons of competing treatments—that would make any surgery a complex one.

Take, for instance, prostate cancer. A study in the Journal of the National Cancer Institute looked at more than 5,100 men with prostate cancer who had radical prostatectomies at four of the nation’s top hospitals.

The patients who were treated by rookies—doctors with less than 50 surgeries under their belts—had a 24% chance of the disease returning within five years. But when you went to the real pros, surgeons who’d done more than 1,000 procedures, the probability of your cancer returning dropped to about 8%.

So if you make the mistake—and it is a mistake—of going to a rookie surgeon, you are tripling the odds that your disease will return. 

Women face the same dangers. In a study of nearly 12,000 women with late-stage ovarian cancer, those who were treated by high-volume doctors at high-volume hospitals had a 31% higher survival rate than those who were seen by low-volume doctors at low-volume hospitals.

But tragically, only 4% of all patients obtained that winning high-volume combination. The majority (53%) passively accepted the bad hand of being seen by a low-volume physician at a low-volume hospital.

For significant problems, go to significant institutions.

The medical literature backs this up again and again. In a 2014 study out of Harvard, researchers wanted to find out if patients who underwent certain risky operations had better results when they were done at “high-complexity” hospitals (aka “significant institutions”).

They studied the outcomes of patients who had one of five common, high-risk surgical procedures: above-the-knee amputation, abdominal aortic aneurysm repair, coronary artery bypass graft, colon resection, and small bowel resection.

Patients who had their procedures done at the lowest-complexity hospitals had a 27% higher risk of death than those who went to high-complexity hospitals.

Think about that: Make the wrong decision about a hospital or surgeon and it could cost you your life!

But you won't make that mistake, because you'll have memorized my mantra: For significant problems, go to significant institutions.

So take charge of your medical care! And get those better medical outcomes that you so deserve. Reap the benefits of less pain, less chance of your disease returning, and, God willing, a longer life—so that you can enjoy many years to come with family and loved ones, doing the things that bring you joy.

Here's to your health!

—Leslie