Friday, 8 April 2016

Cutting costs?

   One of the sub headlines in my national newspaper yelled out at me and the rest of the public, "Surgery longer at teaching hospitals".  It went on to quote a study that claimed on average patients undergoing surgery in a teaching hospital took 22% more time to complete their procedure.  The research doc and his team reviewed 700,000 surgeries over a ten year period from 2002 to 2012, 21% of them in  teaching hospitals and the rest in other hospitals.  He stated that  all 14 types of surgery took longer in the teaching hospitals and the more complex the operation the bigger the gap.  Dr. Vinden, the research leader said the following:  "It will be vitally important to identify at what point this longer duration due to teaching introduces excess patient risk, and to find ways to minimize this risk".   He apparently does not consider that the the patients may be at reduced risk.  Patients in teaching hospitals and teaching facilities frequently benefit from the level of supervision and the generous time allocation in a health care industry where they are frequently rushed through the system.  I do not accept Dr. Vinden's unsupported suggestion of poorer outcome in this circumstance, indeed, I think the opposite may be true.
     Outcome was not discussed, other than to suggest that previous research demonstrated duration of surgery with adverse outcome.  
     I have trained medical students and residents both as a practicing physician and as a full-time academic and I know how much time it takes to teach well.   This particularly applies to complicated procedural items.  Ultimately, poor teaching is much more expensive than good teaching, not to mention the distress and possible danger it causes patients, in the long run. .  Dr. Vinden looked at a tiny part of the picture, implies surgical teaching makes procedures riskier but goes on  to say outcome was outside the purview of his study.   During my early years of recruiting part-time and full time teachers,  I have found them usually to be generous of their time, conscientious in their efforts and in the case of the part-timers often dedicating their time for little or no re-imbursement.   Doctors  have to be trained, there is no way around this, and there is no way around the time it takes to do the job properly.   Poorly trained surgeons and physicians is not a solution. care industry, suck it up and provide adequate training resources, operating room time and faculty time.  And patients, because a huge component of your health care is provided by residents and other trainees, your welfare ultimately will depend on immaculate training.

If you care about how your health care providers are trained, and/or if you avoid seeing a trainee if you possibly can, tell me about it. 

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