Which is most likely to kill you: a head-on collision on Interstate 35 or a hospital visit? If air bags come to mind, guess again. According to a stunning 1999 report by the Institute of Medicine, as many as 98,000 patients die each year due to simple medical errors. That’s twice the number of crash victims—and all because of inappropriate surgeries, wrongly prescribed drugs, hospital infections, and doctor carelessness. (For a worst-case scenario, read “Dr. Evil,” the chilling account of Houston orthopedic surgeon Eric Scheffey.) How can you protect yourself from your physician? The good news is that once-impotent regulatory agencies, such as the Texas State Board of Medical Examiners (TSBME), have been beefed up and given bigger sticks to swing, and hospitals today are more sensitive to malpractice and patient safety. Best of all, the Internet’s huge cache of data on doctors, hospitals, and medications means that patients can finally be true consumers. But it’s all up to you.
Paging Dr. Welby: Finding a Good Physician
To most of us, the idea of doctor shopping is somehow unseemly—or at the minimum, futile. Yes, it’d be nice to find that perfect golf partner, but practically speaking, here’s what you really want to know: Is the guy’s license current? Has he been sued for malpractice? Does he have a criminal rap sheet? Do some sleuthing to find out:
tsbme.state.tx.us, the Texas State Board of Medical Examiners’ site, offers explicit, easy-to-follow profiles of every licensed physician in the state. It tells you if your doc’s license is valid, what his specialties are, if the agency has ever had to discipline him, and if he’s been convicted of a felony. (Such convictions mean an automatically revoked license.) What you won’t find, unfortunately, is the number of times he’s been sued for malpractice or how much he’s had to fork over to plaintiffs; you’ll need your county clerk’s office for that, which can spit out his complete litigation history. But the site’s information is solid, if a little tedious to dig up (locating my personal physician in Dallas took me two tries, as did finding my wife’s uncle, a prominent Fort Worth pediatrician).
healthgrades.com, run by a for-profit health care information company out of Golden, Colorado, is faster and more thorough. It also includes tips, such as why and how you should value a physician’s board certification in a specialty, and automatically guides you to ratings of hospitals in your doctor’s area. The catch? A basic dossier will set you back $7.95.
Get a Second Opinion
No matter how much you trust your doc, if the diagnosis is serious, always find another brain to pick. You’ll fight incompetent, lazy, or greedy medical practice by making doctors compete for your trust. And don’t just go with any Joe Blow your guy recommends; do your homework and find the right expert. If you have to argue with your HMO about coverage, argue. If you lose, find a way to pay for it yourself.
How to Squawk if You Wind Up With a Quack
Call the TSBME hotline (800-248-4062) or file your grievance on its Web site. The board fields only “standard of care” complaints (a wrongly prescribed drug, an unnecessary procedure) or “non—standard of care” ones (behavior such as substance abuse or sexual misconduct). And if patience is a virtue, the process could wind up making you very virtuous. Complaints go through a wringer of investigations and audits, and only about three hundred physicians are disciplined as a result of the six thousand or so complaints filed each year.
Roads to Wellville: Finding a Good Hospital
Fall off a ladder or get in a fender bender, and presto—you’re stuck with the rest of humanity at the closest ER. Still, when it comes to elective procedures, such as back surgery, you do have choices to make. So bone up beforehand:
Jcaho.org, run by the Joint Commission on Accreditation of Healthcare Organizations, a mouthful of a private organization that has been rating hospitals and other health care institutions for more than fifty years, is the most thorough resource for hospital hunting. The dossier I retrieved on my hospital, Presbyterian of Dallas, was twenty pages of hard data, including an in-depth analysis of its patient safety goals. The JCAHO doesn’t merely tell you the hospital’s heart attack mortality rate in comparison with the national average; it also details whether the hospital treats, say, incoming heart attack patients with aspirin or ACE inhibitors or whether it offers smoking cessation counseling, giving you an almost tactile sense of the quality of care.
dshs.state.tx.us/thcic, the Texas Department of State Health Services site, is truly a web—an almost inscrutable one. To get to the most useful data, click on “Hospitals” on the home page, then on “Reports on Hospitals and Health Care.” One more click gets you to a search engine that has cross-indexed Texas hospitals’ mortality rates with other salient data for major conditions, procedures, and diseases. Unfortunately, specific patient-safety facts—particularly hospitals’ rates of infection—are posted only in statewide aggregates, not by hospital, so comparative shopping is impossible.
tbgh.org is sponsored by the Texas Business Group on Health, an association of about 175 companies concerned about health care costs, and offers free information, including relative pricing of procedures: A search of Dallas hospitals cross-indexed with “heart bypass surgery” revealed that while Baylor University Medical Center charges about $60,000 for the operation, it’s $90,000 a pop at Medical City Dallas.
usnews.com, the cyber edition of U.S. News & World Report, finds the best hospitals in your region if you are stricken with a rare or difficult-to-treat condition (click on “Best Hospitals” from the home page). It is selective: Only 175 medical centers in various specialties made the cut from a universe of some 6,000 hospitals. (Houston’s M.D. Anderson virtually tied with New York’s Sloan-Kettering for best cancer center.)
If the Chicken Soup Is Cold and the Nurse Doesn’t Smile
If you think your hospital stay was inadequate or dangerous, find yourself an extra-long envelope and write to the Texas Department of State Health Services’ Health Facility Licensing and Compliance Division (1100 West Forty-ninth, Austin, TX , 78756), call (888-973-0022), or fax (512-834-6653). From there, things may get slow and muddled, as hospital regulation is a joint state-federal affair. The TDSHS evaluates the complaint, refers it to another agency or assigns an investigator if necessary, and determines whether your hospital broke state or federal laws.
Doping Out Your Meds: Finding the Truth About Your Prescriptions
Will that pill the doc just prescribed interfere with your bulldozer driving? Read on before you nod off: nlm.nih.gov/medlineplus/druginformation.html draws its data from the American Society of Health-System Pharmacists and from the United States Pharmacopeia. With its alphabetized drug list and explanations in plain English, it is the most user-friendly site.
pdrhealth.com is the online version of the Physicians’ Desk Reference, the manual your own doctor consults when scribbling those prescriptions. It’s a terrific medical site for any purpose, with a comprehensive medication guide and a listing of available clinical trials across the nation.
When You End Up With a Horse Pill—Literally
If you have a problem with your pharmacy, call the Texas State Board of Pharmacy (800-821-3205) or e-mail from its Web site (tsbp.state.tx.us). If your complaint is valid, an investigator will research the case and issue a report to the board, which dispenses punishment ranging from public censure to revocation of the pharmacy’s license.
Ten Obnoxious Questions Every Patient Should Ask
Don’t be a helpless, wimpy victim. An intelligent consumer grills the doctor, pharmacist, and hospital staff.
- Is the doctor available weekends or at night, if only for a phone consult?
- Can I make appointments within a reasonable time—say, two to three weeks?
- I don’t want to see a nurse practitioner. May I see the doctor?
- What results does my doctor expect from this new pill he’s prescribing?
- How long will I have to take this medication, and what side effects can I expect?
- Is there a generic brand of it available at the pharmacy? (Once a drug’s patent runs out, generic forms are sold at considerably lower cost than the original brand.)
- Can the pharmacist show me some written validation that this is the same medicine my doctor prescribed? Can she tell by looking at the pills?
- How long will I be allowed to recuperate in the hospital after surgery or treatment?
- How often will postoperative dressings and catheters or drainage tubes, a major source of hospital-generated infections, be checked or changed?
- Can a spouse, loved one, or friend serve as my patient advocate during my hospital stay?