Tuesday, September 29, 2009

Practice makes perfect...a message for medical tourism providers and patients

In the largest ever study of hospital mortality rates published in the UK,"death rates for emergency patients jump 6 per cent when newly qualified doctors start work. The Health Services Journal reports that "the traditional first day for NHS doctors is the first Wednesday in August. Researchers found that patients brought into hospital the week before were more likely to survive.....Researchers could not find a definite reason for the higher mortality rate, but said early August was known as an “unsafe period” in hospitals due to the influx of new doctors"
Now, what can we conclude from this?

Might I suggest that doctors with more experience are better than those with less experience? It goes without saying, really.

So, how does this help the medical tourist who is trying to make a decision about which doctor or specialist overseas to choose for their operation? The problem of patient choice in healthcare whether it is a choice of an overseas surgeon or a domestic surgeon is the "how do I know that he's any good?"issue. In the UK, we're probably ahead of the game in enabling patients to make informed choices about treatment. The NHS web site is has been renamed "NHS Choices" and in recent years there's been a drive to expose data on clinical outcomes and surgeon and hospital performance, and make this freely available to patients.

One of the strengths of the UK healthcare system (and one of its shortcomings!) is that the vast proportion of healthcare is delivered by one healthcare provider - the NHS. This means that data on processes, outcomes, performance and patient satisfaction is fairly standardised, thus enabling valid comparisons to be made between one hospital and another, between one specialist and another.

Let's imagine that I need a knee replacement. Under the NHS, I can choose to go to any hospital in the UK, not just my local hospital. But let's assume that I want to stay fairly local. Here's some of the data I can access about my local hospitals through NHS Choices. For each "quality factor", I have highlighted the best result.

Impressed? Which hospital would you choose? Or which hospital would you rule out of consideration? The above table only scratches the surface of the data that is now being made available to patients. I could also compare the quality of the food, levels of service and so on. And I can also begin to make comparisons between individual surgeons.

Where does this leave the medical tourist? The reality is that there are few countries where this kind of comparative information would be made available to the patient. And the reality is that different healthcare systems often measure things in different ways, so that comparing outcome data from a hospital in Thailand with outcome data from a hospital in India might be very difficult.

So, the medical tourist probably needs to ask some very basic questions about the hospital and specialist. One of which is a fundamental measure of "how do I know that he's any good?” It's "how many times have you done this operation before?" "Practice makes perfect" as the recent study demonstrates. Choose a surgeon with experience in exactly what you require. If you're looking for a knee replacement, choose an orthopaedic surgeon who does knee replacements and virtually nothing else. Don't choose a "general" orthopaedic surgeon who does “everything under the sun" - knees, shoulders, feet, hips etc.
And ask the guy "how many have you done this year?"


karim said...

An insightfull post. Will definitely help.

Karim - Mind Power

sisena said...

hi keith,

Great article.I truly agree with you. I think the first step that has to be taken is to ensure that the doctor who treats you has the right qualifications, experience and reputation.

Thanks for the information.

Neha said...

This is a brilliant tip for clients looking at medical tourism as an option for their treatment. Five star sevices in hospitals have become hygiene factors even in developing countries.The main area of focus for the patients should be choosing a doctor, who is an expert in the required field. Clients looking at such expertise should visit our website http://medrefasia.webnode.com//

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robert said...

I am a retired attorney here in the US and would like to see you and Intuition Communication start in the US. We desperately need access to reliable information on all aspects of medical tourism. Please move in our direction as soon as possible. It is clear from your article that US citizens need alternatives, now. Keep up the good work. An aside, there must be a deal over here to be made with our insurance companies. They are always wanting to save money (as opposed to lives). Put them in the medical tourism business. Let them split some of the savings to be had by getting procedures done out of country with the patient.