Health PlaNET

Date: July 16, 1999
Time: 9:17 am

Revealed: the list of worst UK hospitals

The London Sunday Times reported recently that the worst hospitals in England are to be revealed in the first national league tables. Hospital readmission rates show that patients served by Avon and Wirral are three times more likely to have to go back into hospital than patients served by North and East Devon, rated as the best performer. Over 7% of Avon's patients were readmitted, compared to just 2% in Devon.

The best performers appear to cluster in coastal and country areas while the generally worst performers are in the areas that have traditionally relied on coal mining. In addition to the league tables, the government is proposing to send in "hit squads" of experts into the worst authorities to force improvements.

The Department of Health also collected hospital death rates that reveal wide discrepancies but is considered to be a less effective performance indicator. Figures for deaths after hip replacement operations and heart attacks reveal that patients in some areas are four times more likely to die in hospitals than at other. Updated figures will be published in the fall. There are plans to provide more detailed data showing death rates for other conditions.

-- June 13 1999

Losing touch

The Boston Globe reported recently that there are growing fears that doctors are becoming remote, less of the hands-on healers who listened not only to their patients' bodies but their thoughts and fears as well. Symbolic of these fears is the replacement of the stethoscope by more sophisticated testing methods such as the echocardiogram and CT scans. Some feel that this has led to more costly and unnecessary tests; part of the blame for this was put on managed care companies who don't give doctors enough time to maintain their hands-on competence.

Some medical schools such as Harvard University have expanded their training in the use of stethoscopes and other hands-on methods of diagnosis. However, some doctors and medical educators who argue that the ability to use the stethoscope and tap and feel different parts of the body may not be as crucial as it was in the past. Dr. Marshall Wolf, vice chairman for medical education at Brigham and Women's Hospital said that "When I trained as an intern in 1963 and 1964, that's what we spent our time doing with patients - listening to their story and listening to their heart. We listened because we didn't have that much therapy - we couldn't fix the blood vessels or operate on the heart" to the extent now possible.

Dr. Julian Aroesty, a cardiologist at Beth Israel Deaconess Medical Center, counters that auscultation with the stethoscope "a dying art." He believes it's a skill "that has been lost in part because it's not needed as much as it was before - the same reason kids today can't add and subtract because they all have hand calculators.

-- June 7/99

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