Presidential Surgery

Former president Bill Clinton made news this weekend as concern for his health revealed a return to heart bypass surgery which for him was a tuneup to his quadruple coronary. The surgery didn't heal the problem it was a temporary solution to a long term problem. Doctor's revealed the problem wasn't that the former president returned to his bad habits. We initially postulated that it was his failures that brought about the problem. Surgical solutions aren't final solutions and as we continue to promote "couch potato" solutions to health we're gladden by the reports.

But coronary artery disease is a lifetime commitment, Dr. Randal Thomas, director of the Mayo Clinic Cardiovascular Health Clinic and president of the American Association of Cardiovascular and Pulmonary Rehabilitation says. "[Surgery] is a good short-term solution [but] it's temporary; in the long term, the most powerful thing we can do is adjust lifestyle and medication. "Unless we get rid of the underlying problems," he says, the problem will come back.

We searched for local solutions to the bypass surgery and found to our dismay that if we or you needed to have such care the best place to receive it wouldn't be found in the District of Columbia nor even in the traditionally "best hospitals in America." While the places we located were considered by patients and professionals as your best bets for survival and had the lowest infection rates their "quality of care" wasn't equal to the medicine one received. The staff might suck even though the actual surgery and recovery may be the best. We can attest to this from our own anecdotal experiences. While the physician was rude but accurate the nurses were incredibly considerate and attentive.

There are no four or five star facilities in the District of Columbia for Heart Bypass Surgery. There are alternatives in the other local jurisdictions. The Best Hospital for Heart Bypass Surgery in MD -

          1. Saint Joseph Medical Center

The Best Hospitals (4) for Heart Bypass Surgery in NC -

          1. Durham Regional Hospital
          2. Select Specialty Hospital - Durham
          3. Mission Hospitals
          4. Mission Health & Hospital - St. Joseph

The Best Hospital for Heart Bypass Surgery in VA -

          1. Sentara Norfolk General Hospital

Even if you're not an ex-president and we aren't, we can still receive quality care that we can survive if we plan and utilize the best available services from the best available facilities. If we don't, we have only ourselves to blame. If we've got loved ones we can also give them the benefit of our knowledge. We didn't attempt this story until now because of our initial ignorance. We were in disagreement as to whether the problem was a result of President Clinton's lifestyle abuses. It was reassuring to discover it was not (well to some of us).

Dr. Allen Schwartz, the chief of cardiology at the hospital, publicly stated that there was "no evidence of [a] heart attack or [of] damage to [Clinton's] heart," and that what occurred was "not a result of either his lifestyle or diet, both of which have been excellent." (CNN)

Quality Check, our usual source for all things hospital rated was not the most recent source for these local facilities. Becker's Hospital Review magazine names America's 10 Best Hospitals for 2009 none of which made our list. Their choices were, in our area: Duke University Hospital, Durham, NC and John Hopkins Hospital in Baltimore, MD.

While the choices from Health Grades might be your best chances for survival and recovery they aren't the best choices in terms of patient satisfaction. The choices that might be good for you might not be good to you.

They May Excel, But They're the Worst Hospitals for Patient Satisfaction - Patients surveyed give these hospitals, some of America’s best, a poor score overall - Among elite centers in the U.S. News "America's Best Hospitals" rankings that reported patient satisfaction survey results for the year ended December 2008, the 10 percent below were rated worst overall. They had the highest percentages of patients who gave them a 6 or below (10=highest, 0=lowest).

Take, for instance, Virginia's Sentara Norfolk General Hospital which received a patient satisfaction rating of only 16%. While Maryland's John Hopkins considered by many to be one of the best hospital in America received a rating of 75%.

“The fact is, patients are twice as likely to die at low-rated hospitals than at highly rated hospitals for the same diagnoses and procedures,” Dr. Rick May, an author of the HealthGrades study, said in a statement. “With Washington focused on rewarding high-quality hospitals and empowering patients to make more informed health care choices, this information comes at a turning point in the health care debate.” (Seattle Biz Journal)

Our experience reflects that great nurses won't be found with great doctors and great doctors don't necessarily attract great nurses. We loved the nursing staff and care we received but the doctor's attitudes left a lot to be desire. We're they any good? The doctors were incredible. The nursing staff we felt saved our lives. Then again we weren't in for heart bypass surgery either. If we were we'd take rude over sweet but deadly anyday. To use our own anecdotal experiences with Pearlie Mae, her doctor's were the nicest and kindest people we'd ever met. However, the information they gave us wasn't just wrong. It was deadly wrong. We didn't have either access to the information we now have nor any of the rating we're making available to you. If we had, maybe Pearlie Mae would still be with us.

Don’t Wait Or It Will Get Worse

We're always so critical of the press whether its print or TV. The least we can do is when we find something we like we should be as quick to praise as we are to criticize. This morning we found some real stars and some great stories. We shouldn't be so surprised but we are.

Most notable as we constantly quote them, The Atlanta Journal Constitution (AJC), the New York Times (NYT) and Associated Press (AP) not surprisingly. It's not that they don't do good work consistently but they don't remain the source of all news.

We're not a big fan of research that reviews research to reach a conclusion but the story was called: "Deaths After Surgery - Researchers looked at 84,730 people who underwent inpatient surgery at 186 hospitals from 2005 to 2007. They found that death rates varied widely from hospital to hospital, from 3.5 percent to 6.9 percent."

The study of a study was published in the New England Journal of Medicine (NEJM): "Hospital mortality that is associated with inpatient surgery varies widely. Reducing rates of postoperative complications, the current focus of payers and regulators, may be one approach to reducing mortality. However, effective management of complications once they have occurred may be equally important..."

"...In addition to efforts aimed at avoiding complications in the first place, reducing mortality associated with inpatient surgery will require greater attention to the timely recognition and management of complications once they occur."

The researchers of the study of the research were: Amir A. Ghaferi, M.D., John D. Birkmeyer, M.D., and Justin B. Dimick, M.D., M.P.H. The Atlanta Journal Constitution (AJC) reports and you should read the entire story: "Though the new study does not directly address ways to manage surgical complications, "we can speculate," Dimick said. "A number of things in previous studies have been associated with mortality."

"Hospitals with lower surgical death rates tend to have fully-staffed, 24-hour intensive care units with physicians trained to handle post-surgical emergencies. They have high nurse-to-patient ratios in their intensive care units and their wards. "The more nurses the better because there are fewer patients per nurse," Dimick said..."

"A less tangible factor -- "just the culture of the hospital" -- also is involved, he said. "Do people feel afraid to call the surgeon at night, are they afraid to go up the chain of command, are they not afraid of pushing the button?"

We blog so blogs that blog on science and medicine are kindred souls. This time we praise SCIENCEBLOG.com and suggest you read their full story on the study: "The study found similar patterns in the outcomes of specific complications. For example, very high mortality hospitals had similar rates of postoperative bleeding compared to other hospitals, but patients were 50 percent more likely to die if bleeding occurred..."

..."Our study was not designed to identify the 'silver bullet' underlying why some hospitals are more successful than others in rescuing people after surgical complications. However, a patient in need of a major operation should be thoughtful about choosing where and by whom their surgery is performed."

Our obsession is with the lack of available hospital facilities and staff in our jurisdictions. It's not that we believe the sky is falling or that we're in imminent danger for terrorism or pandemic. We believe that the local jurisdictions don't want us to know how wholly unprepared we are for a large disaster. We're just not terrified so it. So far what we anticipate seems like a question of three weeks of more of severe discomfort and deaths. This is horrible and unthinkable but we will survive. Then we can hold the guilty accountable and establish policies to prevent its recurrence.

The AP says that our fears aren't unrealistic. That's most disturbing. "If a third of people wind up catching swine flu, 15 states could run out of hospital beds around the time the outbreak peaks, a new report warns Thursday. The nonprofit Trust for America's Health estimates the number of people hospitalized could range from a high of 168,000 in California to just under 2,500 in Wyoming..."

The story heading is: "Flu might fill up hospitals in 15 states" And continues: "Even though only a fraction would be sick enough to be hospitalized, health officials are bracing: When H1N1 first appeared in the spring, more than 44,000 people visited emergency rooms in hard-hit New York City, the report noted. Just sorting out which patients are sick enough to be admitted from the vast majority who need to go home is a big job. And hospital capacity varies widely. By the outbreak's peak, the new report suggests Delaware and Connecticut hospitals would fill up soonest. Also on that list: Arizona, California, Hawaii, Maryland, Massachusetts, Nevada, New Jersey, New York, Oregon, Rhode Island, Vermont, Virginia and Washington."

At the telephone press conference today Healthy Americans.org released the details of their report. You can listen or download an MP3 of the questions and answers as well as review their report on the District of Columbia and other jurisdictions.