Is Your Community Hospital Worth Your Life
Posted Tue, Apr 27, 2010

Jim lies in a hospital bed clinging to life as I write this blog. Ten months ago he was diagnosed with severe mitral valve disease and advised to have surgery. Jim declined. As his health deteriorated he could no longer put off surgery. He had a choice of going to a community hospital or to a university hospital. He wanted to stay near home so he chose to stay in the community. The morning after surgery as Jim lay in the cardiac intensive care unit he complained of vague chest pain. He complained several times until his nurse said ” Now, Jim, You have just had open heart surgery. You should have chest pain.” Six hours later his right lung collapsed. Several hours later the left. Then kidney function deteriorated. Now he clings to his life.
Kyle needed surgery for cancer of the esophagus. The cancer was limited but Kyle was obese and not in good shape. I told him that if he went to a community hospital he had a 25% chance of dying from the surgery vs. only 1% risk of mortality at a university setting. Kyle wanted to stay in the community to be near his wife. Kyle declined to be operated on at a university hospital in Chicago. Six hours after surgery Kyle’s kidneys began to fail. Three days later he was dead.
The evil secret that no one wants to say is that community hospitals cannot provide the post operative support for major surgery that a university hospital can provide. An excellent surgeon can do his job to the best of anyone’s ability, but life and death hangs in the balance of the post operative care unit. Another evil secret is that affiliations of community hospitals with university hospitals are economic alliances and do not bring the level of care of the community hospital up to the level of the university center.
The trauma of a life threatening disease is difficult at best and emotionally traumatizing. It makes little sense that the welfare of a patient is left to the economic survival of a local hospital or the medical staff of a community center. Decisions like these should not be at the whim of emotions of a confused and traumatized family. The only solution is to have centers of excellence where such difficult surgeries can be most safely performed. In fact, we have the centers and we have the statistics to prove them. What we also have is a politically dominated system that cares more for the economics and welfare of local politicians and health care systems than for the welfare of a patient.
Every patient needs to read the book “How Doctors Think” by Dr. Jerome Groopman. Do this before you need to make a decision. Do it before someone has to write a blog about a person close to you.

Edward Lack
Edward Lack MD is a board certified dermatologist and a board certified dermatologic cosmetic surgeon. He is President and Medical Director of MetropolitanMD, a multispecialty cosmetic surgery center in Chicago,which is unique in having a double board certified cosmetic dermatologic surgeon, a double board certified facial plastic surgeon, and a double board certified cosmetic plastic surgeon. Dr. Lack is also the Past President of The American Academy of Cosmetic Surgery.

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