All Hospitals Are NOT Created Equal

Hospital through the eyes of a patient

Newsflash: Your local hospital may not be the safest place to go if you need medical attention. Scary, right? But depending on your zip code… it may be sad but true.

In late December 2016, the New York Times made waves in the healthcare community when they published a report that highlighted the disturbing differences between hospitals across the United States. This article referred to a new study published in the journal PLoS One, which found that the risk of death may be significantly higher at some hospitals than others.

The researchers behind this deeply concerning report analyzed data about medical outcomes from 22 million hospital admissions. Based on their analysis, they found that there were massive variations in outcomes between hospitals in this country. After adjusting for factors such as illness level, income level, and age, the researchers found that the risk of death may be up to three times higher at particular hospitals.

The New York Times stated:

“In the first comprehensive study comparing how well individual hospitals treated a variety of medical conditions, researchers found that patients at the worst American hospitals were three times more likely to die and 13 times more likely to have medical complications than if they visited one of the best hospitals.”

That’s a frightening finding, and it really illustrates the harsh reality of encountering the health care system in the United States. This is also not the first study to show how dangerous our health care system can be. A 2016 study published in the journal BMJ found that medical error is the third leading cause of death in this country.

That’s right… although “medical error” is not ranked among causes of death by the CDC, Dr. Martin Makary, leader of the BMJ study and a surgeon at Johns Hopkins, deems that it should be. When they ran the numbers, Dr. Makary and his team found that over 250,000 Americans are killed by medical errors each year. This puts medical error third in line for leading causes of death, behind only heart disease (which kills about 610,000 people per year) and cancer (which kills just over 595,000). These numbers are staggering.

Based on their study, Dr. Makary and his co-authors wrote an open letter to the CDC, urging them to add medical errors to their list of leading causes of death. It’s a serious matter, indeed.

One of the fundamental problems with what we call our “healthcare system” is that is really is not a healthcare system at all. It’s a disease-care system. It is a system that uses powerful tools like drugs and surgeries to treat diseases. There is some emphasis on the use of screening tests for early detection of disease, but there is almost no attention placed on true prevention. When we encounter a system that uses such powerful tools, we should expect powerful effects… including adverse consequences.

Think for a moment about a fly buzzing around your kitchen. What are your options? I happen to be a gentle human so It should come as no surprise that my first choice is to open a window and try to shoo the fly out. It takes some effort and some time, but it usually works. But if that doesn’t work… there are certainly other options. There’s the rolled up newspaper. There’s the flyswatter. And if those don’t work, we can ratchet up the intensity even more. How about using a can of toxic chemical insecticide spray? Or even an all-out assault with a sledgehammer… or a flamethrower. You’d have a dead fly… but you’d destroy your kitchen in the process.

One of the biggest problems in healthcare today is that the system relies way too heavily on the “big guns” like the insecticide spray or the sledgehammer (drugs and surgery). Most physicians have little to no training or experience in the use of safer, less powerful options. It just makes sense to start by opening up the window and then moving to more aggressive options if necessary.

To begin to heal our nation’s health care system, we need to redefine and reimagine our approach to medicine. We need to embrace using only the minimal amount of force necessary to achieve the desired result. If we approach medicine like this, we can save a lot of lives — maximum health with minimum harm.

– Dr. Joshua Levitt