There’s an old joke that goes,

Question: What do they call the person who graduates at the bottom of his medical school class?

Answer: Doctor.

I was reminded of that joke by this article,

Study: Five-Star Hospitals Might Not Kill You.

If all hospitals performed as well as 5-star facilities, as ranked by an independent healthcare ratings company, 237,420 U.S. Medicare patient deaths could have been prevented between 2005 and 2007.

This is true. And if every police department in the country ran like the ones I see on TV, no crime would go unsolved. Unfortunately neither is reality. On TV they can write the script with no regard for the actual details of law enforcement. In medicine, there are only so many really talented doctors and other staff. Now, I’ll admit that 99% of doctors are either smarter than I am, or at least they just paid more attention in school. That being said, not every doctor is Albert Schweitzer, not every nurse is Clara Barton, not every paramedic is Ambulance Driver. The bell curve exists in medicine as it exists in everything else.

Just about any hospital can handle the run of the mill stuff. For the most part, although a friend of mine’s son was treated for a large cut to his hand several years ago and the doctor “forgot” to order Xrays. So, she missed the chunk of wood that was embedded deep in the wound and sewed it right in there. Where it managed to cause quite a nasty infection. Fortunately, my friend took his son to a different doctor when the hand started to blow up and turn ugly colors.

Fortunately, that sort of thing is fairly rare. Chances are it would have been even less likely to happen in a larger hospital with presumably better doctors.

The reasons that the better doctors tend to go to the better hospitals are pretty straightforward. More money, more interesting (that means sicker) patients, better opportunities for research and teaching. If you are a really smart doctor, better hospitals are going to be looking for you and will throw considerable amounts of money at you. Doctors at the top hospitals not only develop new treatments and techniques, they get to perform well established ones more often than other doctors. I don’t care if it’s stitching up a cut on my hand or doing a cardiac bypass, I want the doctor that’s done 1,000 of them and not the one that does ten a year.

The same goes for nursing to a large extent. Really good nurses never have to worry about finding a job. Again, more money, more interesting patients, more opportunities for advancement. There are exceptions and I know of one hospital that pays their nurses less than many others in the area because of the supposed prestige of working there. Try paying for that next tank of gas with a pile of prestige and get back to me on how that works out.

It’s probably the same for lawyers, I’d guess. The top graduates in law school go to large firms and make a lot of money. The not so good ones run for US Senate. The really bad ones advertise on TV and make a lot of money. But I digress.

Although it would be nice if all hospitals performed equally well, I don’t expect to see that ever happen. There just aren’t enough top notch doctors and other medical professionals to go around.

I’m going to give you one concrete example of what I mean. I have a very close friend who has a child who has a pretty rare medical condition. It’s a serious condition and needs the very best doctor practicing in this highly specialized field for his child to stand any chance of getting better. For three years he made the trek from his home in New England to New York City to see the doctor that everyone told him was the best in the world for this condition. A couple of months ago that doctor suddenly retired. So, my friend once again sought out the best doctor for his child’s care. Who happens to be in Denver, CO. The second best doctor is much closer. After that it doesn’t really matter because the drop off between second best and third best is significant.

This is an extreme example but some conditions demand the absolute best possible care no matter where you have to go to get it. It would be much better if there were ten “best” doctors for every condition, conveniently located around the country. But there aren’t and never will be.

Something to think about the next time a doctor tells you that your community hospital can treat that complex medical properly.