Wednesday, October 17, 2007
A while ago I wrote about choosing a surgeon. Related is the decision to have care (surgery, of course, would be the subject here) in a community hospital, as opposed to the famous medical center. A commenter on a recent post referred to the BHD, the "big hospital downtown." I'll call it the BFH and let you figure out what I mean.
Like everyone else during training, when I was at a BFH learning to be a surgeon, I basked in the belief that I was at the only place a person could go to get good care. I thought derisively of the silly referring docs; so did my confreres. I even wondered how I'd be able to care for my patients when I didn't have a retinue of people following me around happily (or not) doing whatever I asked, as I did when Chief Resident. It took a minute or two in practice to disabuse myself of the mythology.
Think about it: if those BFH's are so wonderful -- and in many ways they really are -- ought it not be the case that the people they train to go out into the world are also pretty damn good? Is it only within the great walls that folks have mystical powers? Powers that poof when passing the portals on the path to private practice?
Wisdom may be generated in the BFHs but the whole idea is for it to flow outward. Most treatments for most diseases have been pretty well worked out, and the information is readily available. And as it evolves, the news spreads. If it were really the case that the only people who know what they're doing reside within a BFH, wouldn't that mean that they'd failed in their central mission? That they'd created incompetents and loosed them upon the populace?
The fact is that when I began my practice, I felt I'd been very well trained; nor was it self-delusion (trust me, I'm a doctor). And, by golly, I found it was easier to get things done, to provide personal and expeditious care when all the BF accouterments were stripped away. With academic largess come layers, complexities, and, yes, arrogance. The most stunning thing in the comment I referenced above was the demand by the BFH that care be transferred up front, sight unseen. While I doubt such a thing is universal, it's revelatory.
It's decidedly NOT my position that people should avoid the BFH. Were that to happen, the system would grind to a halt in half a generation. And clearly, for very specialized care -- transplants, for example -- such places are the only places to be. It's just that for most care, given a little time to check out the local folk, I believe strongly -- based on years of observation and participation -- that excellent care is available in most community hospitals; people should feel good about that. (So as not to upset anyone, I'll stop short of saying that for the commonplace, care is better in the community hospitals; but that's what I believe. Given the right players.)
[In re-reading my earlier post, linked via the fifth word of this one, I realize I've said much the same, in different words, previously. This means two things to me: 1) it's tempting to re-write a lot of what I've written in this blog, and 2) I'm starting to bang against the bottom of my brain. It bodes ill, futuristorically.]