Or any other source, outside of real hard data, that is? I ask this because, in my capacity as a benefits consultant, I often hear employees say that they know we have the most expensive system in the world (although few know to what degree), but they feel that is a fair trade off because we have the BEST health care system in the world.

Read: U.S. still lags behind other countries in health care

Well, let me disavow you of that notion. Every metric measurable shows that we have a mediocre system, at best. The World Health Organization ranks the U.S, as 37th in the world, strictly based on outcomes. That puts us tied with Slovenia, but significantly behind countries like Costa Rica, Saudi Arabia, Colombia, and the bankrupt country of Greece.

Part of this, I believe, is because we don’t ask hard questions on the quality of care we receive (and likely wouldn’t get answers, if we did). Does anyone know the readmission rate or infection rate of the hospital they are about to have a surgical procedure in?

Stephen Dubner, of Freakonomics fame, asked the following question: There are two major cardiology conferences each year, where more than 7,000 of the top cardiologists and thoracic surgeons go for 1-2 weeks each. What happens to the quality of care in the facilities in which the top doctors are attending the conference?

Before listening to the data, that was pulled from 10 years of data from Medicare looking at over 10,000 patients, I tried to imagine, would I want to even go to the hospital knowing my cardiologist, or the top doctor in the department, was away? The data really looked at emergency type of heart conditions (like heart attacks) where “choice” of facility is largely removed. And it looks at teaching hospitals vs. non-teaching hospitals.

Conventional wisdom says “Take me to the facility with the top doctors and keep me away from a teaching hospital. I don’t want any residents cutting their teeth on me.”

But the data speaks to what should be a very different response.

If you were brought to a teaching hospital for a heart attack, during one of the two conventions, your mortality rate is about 15 percent. Mortality rate at a non-teaching hospital the week before or week after the convention? 25 percent. This is a HUGE swing. This means for every 100 hearth attacks brought in, 10 more people die when the top doctors are around.

Let me put this in perspective. If you look at all treatments given when having a heart attack — like beta blockers, Plavix, stents, angioplasty and aspirin — all these combined reduce mortality by 2-3 percent. So you are far better off getting to a teaching hospital where the top cardiologist is at convention than getting all the standard treatments alone.

And here is another interesting point: The amount of invasive treatments, such as angioplasty and stents, are utilized in about 33 percent fewer cases when the cardiologists are away.

Ok, so wait a second. Did I just say that better care is given when the top doctors are away, and at the same time, less severe treatments are being administered and less dollars are being spent? That sounds pretty counter intuitive. Let me give my take on why.

When I think of a “top” cardiologist, an image comes to mind: He has lots of gray hair (not sure why my mind imagines a male, but it does, nonetheless), and has been doing cardiac surgery for decades. Does this sound about right?

Well, this doctor was trained in medical techniques 30 or 40 years ago, and they have likely been sued for malpractice, perhaps multiple times (which leads to “defensive” medicine), and frequently they have ownership or at least compensation tied to the profitability of the facility they practice in.

These traits lead to “more” care, and often inappropriate (or unnecessary) care. Whereas the younger doctors, less jaded by malpractice and less engaged in profits, and more recently trained, might provide a more idealistic approach to treatment, and reinforcing the “less is more” theory in evidence based medicine.

Want to hear more details on this? And the reactions from the cardiologists themselves when asked at the actual conference referenced here what they think of the study showing care improves while they are away? Listen to the whole story here.

So, I ask you to question EVERYTHING when it relates to care. Assume nothing. One thing is clear: The more involved the patient is in their own care, the better the outcomes (and the lower the costs too).

Instant Insights /

Why you need to question everything about health care

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