Sunday, July 09, 2006

The Importance of Your Local Doctor

Ranking of hospitals have become a huge industry in America – just look at the recent coveted US News and World Report hospital rankings published this week, to Solucient’s 100 Top Hospitals in America. Hospitals clamor for the right to make such lists. The marketing opportunities for these lucky hospitals are significant. Dollars for research and low-priced infrastructure loans follow. But does this represent a false dichotomy for our patients? What is “best” for our patients? For the general populace, is it “best” for them to see the World’s Greatest Doctor at the World’s Greatest Medical Center to provide treatment or recommendations but wait weeks to see that individual, or is it “best” to have local and timely treatment by the average doctor? Certainly, the treatment of rare diseases at centers with broad experience in that malady has merit. But for the population at large, especially for those geographically separated from such centers, such rankings might fail people – especially those with common, chronic conditions.

My father has always insisted on getting his health care at Mayo Clinic, one of those exceptional medical centers rated by the US News and World Report magazine. He would travel there and spend a week or so getting every test known to man to assess his current conditions of heart disease, diabetes, lung problems, and kidney problems (none of them rare), and be levied with numerous recommendations for ongoing care when he returned home to the Chicago area.

But a curious thing happened upon his return. While he would carefully follow the doctors instructions (he compulsively managed his insulin-requiring diabetes well), he never found a local doctor. He would leave his health care to the "Mayo" and arrive there annually or bi-annually as the need arose, and feel vindicated that his health care was the best there was. After all, no local doctor could fulfill all his medical needs under one roof. Because of his lengthy medical problem list, it was easier for him to travel to Mayo and "get it all done" rather than have multiple appointments with multiple specialists. In a way, I couldn't argue with him.

But after years of ongoing medical issues and Father Time's inexorable march, his health care situation has become increasingly complex. His medication list reads like the Encyclopedia Britannica. Changing one medication might have rapid and significant implications for the other organ systems involved. Clearly, trips to Mayo on an every-other-day basis or even weekly basis no longer make sense - both medically and economically. He needs a local doctor. Day-to-day evaluations remain invaluable to health care of individuals at this stage (and my father is not unusual) - and might save lives. Are we risking delaying evaluations of individuals as they wait for appointments at the Great Hospitals in the name of prestige?

I was recently shown a set of my father’s blood test results received from a local physician on a day he wasn't feeling too well. The panel demonstrated abnormal electrolytes and crummy kidney function - worse than I recalled from earlier tests I had seen. I urged my father to get a repeat test the next day, but he insisted after significant arguing to return to Mayo for further evaluation. He's there now and due to seen by the nephrologist tomorrow, over half a month from the date those abnormal test results returned. He still doesn't trust our local health care system. Stubbornness and control won out over common sense. Could the marketing of the Greatest Hospitals have affected his judgment?

While hospitals scramble to make this new list of America's Most Wanted Desired hospitals, we must not lose sight that this ranking system does nothing to provide the local day-to-day care required by the majority of Americans with chronic medical issues. To complicate matters further, the idea of hopping on a plane to access “the best” centers is emblematic of a class-divide in health care in America. Go forth, oh wealthy ones, and prosper. Certainly not a model for health-care for us all.

But before when he left for Mayo this time, my father acknowledged that the trip from Chicago, Illinois to Rochester, Minnesota was getting tougher for both he and my mother (who now must drive), and he agreed to allow me to help find him a local doctor who is willing to take this bull by the horns. And I assured him, there are lots of capable doctors here in Chicago who can coordinate and facilitate his care that aren't on the US News and World Report's list.


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