Newspaper Page Text
PAGE 4B
Reporter
January 21, 2009
Health expert: Local hospitals often best
Health experts say community hospitals like Monroe County Hosiptal, whose staff is shown above, often give better
care than the nation’s top university hospitals.
This article originally
appeared in the Boston
Globe on Dec. 28, 2008.
BY MARCELLA
BOMBARDIERI
Dr. Donald M. Berwick
may be the most influen
tial figure in a global
movement to improve the
quality of healthcare. His
organization enlisted 4,000
American hospitals in a
campaign to dramatically
drive down medical mis
takes that kill tens of thou
sands of people a year.
So, where would he go if
he had pneumonia?
"Right now if I needed
something simple, I would
tend to choose a great com
munity hospital over a
great academic hospital,"
said Berwick, leader of the
Institute for Healthcare
Improvement in
Cambridge. "There's a lot
of reasons to suspect that
for relatively routine
things you need . . . you
would be better off at a
caring, smaller community
hospital that's taking qual
ity seriously than in a
massive, complex teaching
hospital that's taking qual
ity seriously."
Berwick's beliefs about
routine care rest on a mix
of data and instinct. They
infuriate many academic
doctors proud of the
extraordinary knowledge
they apply to curing their
patients and training the
next generation of physi
cians.
"If I needed to have my,
I'll say, toenails clipped, I
wouldn't go to Mass.
General. OK. Probably
that's true," said Dr. David
F. Torchiana, head of the
Massachusetts General
Physicians Organization,
when told of Berwick's
comments. "Where does the
line diverge? When would
he go to Mass. General?"
Yet Berwick's point of
view is gaining currency
among other prominent
doctors and researchers,
who believe that teaching
hospitals can be too busy
handling all manner of
complex care to always get
the basics right, or that
community hospitals have
worked harder to improve
quality in recent years
than their academic coun
terparts. Even the CEO of
Partners Healthcare, par
ent company of
Massachusetts General
and Brigham and Women's
hospitals, says he considers
academic and community
medicine equal in quality
except for complex care.
"If I felt there was a dif
ference, I wouldn't move a
patient from the Brigham
to the Faulkner or from the
General to North Shore,"
said Partners' leader, Dr.
James J. Mongan, referring
to hospitals within his sys
tem.
If there is a such a rela
tive equivalence in quality,
it isn't well reflected in the
Massachusetts healthcare
market. More than half of
discharges were from
teaching hospitals last
year, according to the state,
and the vast majority of
them were for care that is
available far more cheaply
in community hospitals.
Generations of conven
tional wisdom - and years
of hefty advertising by
teaching hospitals - have
reinforced a belief among
Bostonians that the best
treatment for nearly any
illness can be found at one
of the city's monuments to
medical greatness. It is our
particular regional obses
sion; one study found that
only a fifth of hospital
stays in other states are in
academic centers.
Berwick does believe that
teaching hospitals are best
for some illnesses. For a
triple-vessel bypass or
esophageal surgery, for
example, he would choose a
teaching hospital, where
doctors are generally more
experienced at performing
rare operations.
But when it comes to rou
tine medicine, he and other
healthcare specialists said,
teaching hospitals, despite
their many areas of excel
lence, can have a downside.
They are enormous places
with layers of doctors and
nurses juggling a lot of
very sick patients.
Miscommunications occa
sionally happen.
Emergencies can distract
from other priorities.
Still, there's no definitive
answer to the debate.
Studies are contradictory.
Barometers of medical
quality are fairly embryon
ic - and controversial.
But there are efforts on
many fronts to devise more
persuasive comparative
measures. In one example,
Sir Brian Jarman an emer
itus professor at Imperial
College in London, has
developed a method to cal
culate the death rates of
entire hospitals in a way
that they can be compared,
despite differences in how
sick the patients they see
are. Jarman found that in
2000, 39 elite academic
hospitals in the United
States had a lower death
rate than all other hospi
tals in the nation. By 2006,
however, the situation had
reversed. Both kinds of
hospitals had seen their
mortality rates decline sig
nificantly, but the elite hos
pitals now had a higher
death rate than the rest.
Jarman, who has worked
with Berwick's group,
believes the community
hospitals have worked
harder to improve. Many
teaching hospitals, he said,
"probably feel they don't
need to do all this stuff,
they're good enough as it
is."
Avery Comarow, editor of
the U.S. News & World
Report ranking of
"America's Best Hospitals,"
said teaching hospitals are
best for patients who need
complex care and have few
alternatives. Others should
feel safe looking more
locally.
"If you are 45 years old
and need a knee replace
ment . . . and you don't
have other complications,
why not stay close to
home?" he said. "Ask the
right questions about how
many [procedures the sur
geon and the hospital]
have done, about their
mortality rate. If the
answers are good, why in
the world would you go
someplace else?"
Article courtesy Monroe
County Hospital.
Brighten up your child’s
toothbrushing experience
As any parent knows,
getting kids excited about
anything that isn't the lat
est toy or gadget is a hard
sell. When it comes to get
ting kids excited about per
sonal grooming habits, par
ents know the task is even
taller than usual.
Perhaps no grooming
habit has proven more of a
challenge over the years
than proper dental care. As
hard as parents may try,
kids seem to have an
innate aversion to brush
ing their teeth.
Recognizing that, here are
some tips for parents to get
kids excited about taking
care of their teeth.
* Make brushing fun:
Even parents can admit
that brushing your teeth
isn't the most fun thing a
person does every day.
However, that doesn't
mean this morning and
nightly ritual can't be
spiced up with a little cre
ativity. Thanks to his own
daughter's stubbornness
when it came to brushing
her teeth, Dr. Fresh was
inspired to add some daz
zle to dental care. By tak
ing the LCD light out of a
pair of fancy sneakers and
placing it in the bottom of
a regular toothbrush, Dr.
Fresh did just that. After
some more thorough
research and development,
the Firefly(R) was born.
Employing the same blink
ing technology used in a
pair of sneakers, the
Firefly blinks for 60 sec
onds, instilling the dentist-
recommended one-minute
per arch brushing routine,
but doing it in a way that's
fun for kids.
* Take the hurt out of
brushing: One of the fore
most reasons many kids
don't like
brushing or
even trips to
the dentist is
the pain prin
ciple. Kids,
and even
adults, often
associate den
tal care or
dental visits
with pain.
That's why Dr.
Fresh recommends parents
go gentle on young gums. A
brush such as the Firefly,
with its soft and individu
ally rounded bristles, is the
perfect way to comfortable
dental care. In fact, den
tists have even recom
mended the Firefly to
adults who have experi
enced difficulty with the
harder bristle brushes
made for men and women.
* Start early: Good dental
care habits start at a
young age. Unfortunately,
so do bad ones, emphasiz
ing the importance of rein
forcing proper dental
habits in children as early
as possible. Studies have
shown that childhood tooth
decay is reaching an epi
demic level in the United
States, and it's been well
documented that cavities
in baby teeth set the stage
for cavities in adult teeth.
Dental professionals rec
ommend replacing a tooth
brush once every three
months. In fact, the lights
on the Firefly toothbrush
stop functioning after the
optimal number of uses,
reminding kids and par
ents alike that it's time for
a new toothbrush. By giv
ing kids a new, bright and
blinking toothbrush when
the light stops blinking,
you can renew kids' inter
est in brushing their teeth
simply by following your
dentist's guidelines.
Article courtesy of Dr.
John Bowcock and Dr. Stan
Hickman of Family
Dentistry in Forsyth.
Come meet our newest providers,
Dr. Thomas Williamson
and
Christy Harrell, PA-C
Dr.Thomas Williamson I Dr. Patton Smith | Christy Harrell, PA-C | Dr. Stephen Taunton
The Doctor's Office, LLC in Forsyth 478.994.0437
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