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Monday, March 26, 2012

Hospital and Dr. Rating systems. They are Worthless.

I have been able to book appts with two different Dr.s that were ranked very high by their peers(Best Doctors lists). We saw each of them once and though they were nice, they weren't what I thought "Best" should be.. Turns out, a lot of those rankings and lists, well they are mostly based on peer recommendations, not patient feedback...

Clearly, I have a much different view of what makes a Top Dr, then a Dr.

Apparently, Best Hospital lists are often generated in the same way. The more employees that fill out the survey with positive feedback the higher the rank.

I appreciate that other Drs. have qualifications that I don't in judging whether a Dr. is good or not, but whether a patient thinks a Dr. is good or not is going to influence their reputation. I would much rather hear from patients.

US News list is the one most easily found. A couple of Houston hospitals consistently make the Top 10 using the US News criteria(based on Drs,nurses,and survival)

The very first thing I noticed is that they use this criteria- Reputation with Specialists, Nursing Staff, and Survival. Where is the patient input? How many Children's hospitals are in the area to chose from?(larger the metro and fewer the pediatric speciality hospitals the easier it is to rank higher) How many patients did they see? Were the patients all referred? Were they Public or Private? What was the waiting time to be seen? How many of the patients they saw were they able/willing to treat or diagnosis? These are factors that are as important. Granted, I feel strongly that a happy and quality nurse can make or break their Dr- I cannot tell you how many Drs. I have abandoned because their Nurses were horrible. And, of course I want specialists who know about medicine to rank- and kind of obvious that survival is important- but what about all of us patients? Are we just a slab of bacon?

So I found this link next which is based on 12 years of Medicare Data- the list was generated by Health Grades. Texas did not even make the top 10.

Humm- that is a significant difference so I decided to find another ranking and found this article from the Los Angeles Times: here is a little snip that pretty much sums it up-

The findings surprised Sehgal. ("I nearly fell out of my seat," he says.) According to his analysis, reputation dominated the rankings, especially near the top of the list. The study found that if the top 20 hospitals in 12 categories had been ranked on reputation alone, the results would have been about 90% the same as the actual rankings. (The study didn't include the four specialties already ranked solely on reputation.)

And when Sehgal compared reputation scores with the other factors used by the magazine — such as death rates, technological resources and nurse-to-patient ratios — he found that those reputations didn't necessarily reflect reality. "There was virtually no relationship between reputation and objective measures of quality," Sehgal says.

So as patients who do we trust? IS there a list that considers patient rankings as seriously as they do other Drs.? Not one even close to the popularity of US News or Consumer Reports. As I stumbled through my googling I found some patient based lists but most were way too small, or were old, or were just patient ratings, which is as about as pointless as just Dr. Ratings.

I continued to try different search terms and found this ranking system via ModernHealthcare.com. It broke down the ratings by profit, or busiest ER departments.. So I thought, Yes this list and ranking might be helpful. I went to the Busiest ER ranking- to my disappointment they want me to pay 45.00 to see their rankings. So again, I the consumer- the patient feel very much like my input has no value beyond a survival rate as a slab of meat.

The last one I took the time to read this morning was from Medscape. It was an interview with a University of Pennsylvania School of Medicine. He was far more articulate then I was here, but he too questioned the value of these Top Hospital and Drs. lists. My favorite snip from his interview-

At the end of the day, what would be helpful for physicians and patients to know would be where patients do better, and which types of patients do better at which institutions, because I suspect that it varies tremendously. What specific area of expertise might a particular institution have? Much of what we do as nephrologists is take care of dialysis patients in and out of the hospital. Perhaps that is a measure by which hospitals should be ranked rather than nurse staffing ratios, patient volumes, and things that may or may not translate into better outcomes for patients.

I understand that "emotions and feelings" are hardly easy to rank. But, wouldn't even knowing a ranking based by Patient recommendations to recommend the hospital or Dr. to another patient be very helpful to the patient? But, then we aren't the Dr., The Nurse, The investor, The City Marketing community, The Medical School.. to them a ranking based on patients isn't nearly as important as their "peers."


Jenna said...

I hate that it is so hard to know what hospital is best to work with.
I have a system here, if we have a problem that is a typical child problem we go to one hospital because it the fastest and we are in and out. If it is anything severe where I want to be heard I go to a different hospital and wait for many hours. It would be nice if there were more reviews from the patients prospective.

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