Loss of trust in US healthcare
I am not the only one commenting on drop in quality of US healthcare.
As a retiring cardiovascular surgeon, I still have many friends, ex-patients, and fellow doctors asking my opinion on doctor referrals. Let me first say those huge Highway Bulletin board ads are a total scam. Advertisements promoting Hospital Systems as “Top Five in USA” or “Best in Houston” are usually totally an advertisement scheme. They get those “ratings” based upon advertising money they have spent with that magazine, or advertising system. Do NOT trust those signs !! Having said that, some of those “systems” have some truly outstanding and excellent doctors and surgeons, but you need to know who to ask for in your referral. If your GP says your need a referral for an operation, ask him/her —”are the surgeons you referring me to all board certified?” Even better, ask for the GP to give you the NAME of who the referral is going to…. and then pop the Question “IS Doctor XXXX board certified in that specialty and has he/she maintained their board certification?” Realize that the Grandfather rules regarding recertification all were modified about 1975 or so. The Medical - Surgical boards all came about in the 1930s, 40s and were an exam.. Usually written followed by an oral exam. The old docs who put this together weren’t money grabbers. But eventually the boards realized it was a money making scam.. and they started requiring a “10 yr recertification” to do it all again, then they started requiring an annual registration fee, then they started adding to that a middle of certification “MOC” requirement where you had to do another exam at five years, which cost more money, and to add to it the exam was run by same outfits and the exam cost money… Surgical Education Self Assessment Procedure (SESAP) by American College of Surgeons in General, vascular, hand, burn surgery or the SESATs from American Board of Thoracic (cardiac) surgery. Most all the boards have done this. All were expensive, but if you didn’t do them, the board would say you were not current on your certification should a hospital call to check on you. Sort of an automatic crowbar on your wallet - and while some hospital systems provide money for that, the great majority of doctors pay out of their own pockets. If you want to know if your doc is certified, call the American Board of (fill in the blank)
So, know that it is still important to find a surgeon who is board certified… and allow me to be crass, but not one who has just “gotten off the boat!” Having said that, some of the best surgeons I know, worked with and refer to are foreign born and educated overseas doctors. However most all have received some US training and all the good ones go ahead and get the American boards.. even though they might be Fellow in the Royal College of Surgeons (FRCS) in their home country.
A recent compilation of media articles have pointed out the problem……
Less Than Half Of Adults Rate US Healthcare System As “Excellent” Or “Good,” Survey Shows
The Hill (1/19, Neukam) reports, “Less than half of respondents in a new Gallup survey have favorable opinions of the U.S. health care system, with a majority saying it is only fair or poor.” This marks “the first time since 2001, when the survey giant started recording feedback on health care in the U.S., that less than half of respondents (48 percent) said the system was excellent or good.” The results revealed “the price of obtaining health care in the U.S. is” one “sticking point for respondents, with just 24 percent saying that they were satisfied with the total cost of health care in the country.”
CNN (1/19, McPhillips) adds that “satisfaction with health care has remained high among older adults ages 55 and up but declined among young and middle-age adults.”
Hat tip to Texas Medical Association newsletter for above quotes. Links work.
Health care systems often track quality and use institutions to do that such as the “Press Gainey” survey. I just saw my GP a couple days ago and by yesterday I was filling out the survey.. Really “important— not!!!” stuff - like 1. did you feel safe 2. did the provider wash their hands, 3. did provider answer all your questions? etc. It truly is a nothing burger survey I would say.. I gave my doc top ratings of course.. but when it came to question about “would you suggest referral to our “Big Hospital System” doctors… I had to not rank much lower for the system because although he is superb, the system has a bad reputation and hey I used to work in that system in the past. I have seen all the dirty linen and there are some docs I wouldn’t take my dog to in there. That is why I pay for out of my pocket an “Air-Evac” insurance card that will fly me to whatever hospital I want in the state of Texas. I will go to a known entity DOCTOR who I trust and he or she may not be at the closest hospital to me here.
Some of other quality issues are only what can be gathered from inpatient care…examples are 1.) urinary tract infection after Foley catheter placement 2.) Deep vein thrombosis or Pulmonary embolus 3. death after surgery and obvious markers such as those.. (might make for an interesting study post COVID - but don’t expect anything as most the COVID related side-effects which are obvious on TV when the host/actor/sports player falls over dead.. the in hospital medical COVID complications will get hidden from public view. But back to quality.. Let’s say it is not good for a surgeon to 1. have a high percentage of “take backs” for postoperative bleeding due to improper hemostasis during the procedure, 2.) Keeping patient under anesthesia for 6hrs for an operation that takes normal surgeons 2-3 hrs, or even worse….3.) Using a “ROBOT” to take six hours to do a 2 hour operation… AND still having to open up or take back later because of bleeding… ugh. Shall I say the list goes on. I have a suggestion… if you are planning to have surgery find a grey haired doctor or nurse and ask who is the best board certified specialist in that hospital to do your procedure.
Obama wanted us to have equality in medicine.. with other countries. We have been dragged down to the level of the “Cuban bare foot doctor” Castro so wanted… Of course when he needed surgery… well you know the rest of that story. I might add some of my most superb colleagues in practice were Cuban docs who escaped the nightmare of Castro and came to the USA.
The certificate below came from a group who prints a magazine… but to get the certificate, you cannot pay for it…. fifteen doctors from your town (Dallas) have to recommend you for that specialty to get the award… just saying… I didn’t buy it. It is based on specialties.. This was for Cardiovascular surgery. A yearly thing.