Question Authority! Navigating the Medical Industry

Folks, I want you to bookmark and also write down the URLs for these two sites:

Medicare.gov’s Hospital Compare search engine (http://www.medicare.gov/HospitalCompare/search.html)
Health Grades (http://www.healthgrades.com/)
Health Grades’ Hospital Directory (http://www.healthgrades.com/hospital-directory)

Hang onto these. Sooner or later, you’ll need them, unless you drop dead out of the blue.

To get the mammogram that led to the speculation that I may have breast cancer, I went to St. Joseph’s, a vast medical center in downtown Phoenix — only because my gynecologist is on the teaching faculty there. It has a good enough reputation, other than the Church’s having fired and excommunicated an administrator and ethics board member because she approved an abortion to save the life of a patient who was had a 100% chance of dying if the pregnancy continued. And other than the fact that I almost died there some years ago, when I couldn’t even get triaged after showing up at their ER with acute appendicitis. But those, of course, are different stories.

Yesterday, after I finally began to calm down a bit, it re-entered my hot little mind that I won’t even have a dental procedure done without a second opinion. So why on earth would I let someone have at my boobs without a second opinion?

Emboldened by this thought, I called Young Dr. Kildare’s office and asked tentatively if he would be interested in chatting about this. His nurse basically said “uhhhh… I’ll ask him.”

Then St. Joe’s called to set up the biopsy. They only do these at 10:30 in the morning. I explained that I teach four days a week, and that my pay will be docked if I don’t show up. That  left only Fridays, and (fortunately, I suspect), this Friday was taken. So the thing is now scheduled for the 20th.

This buys some time.

Charley woke the Pup this morning as the sun’s first waves of electromagnetic radiation seeped over the eastern horizon, and they started to lobby to get up and play. That rolled me out of the sack at 4:30. More time purchased: I used it to do a little research.

Here’s what I found out:

First, I found this article, reporting on research that suggests mammography can lead to unnecessary procedures, and that some scientists believe women over 70 or 75 should skip the routine screening altogether. For women between 50 and 70, however, routine mammography may reduce the risk of death from breast cancer by 20 or 30 percent.

I’m not 70 yet, but I will be in less than a year.

Following a link in that article, I came upon a risk assessment tool at Cancer.gov that puts my chance, at age 69, of developing breast cancer within the next five years at 2.2%, exactly at the average risk of 2.2%. The site notes that this means my risk of NOT developing a breast cancer over the next five years is 97.8%. My risk of getting breast cancer between now and age 90 is 6.6%.

Hm. Kinda different from the 50-50 chance the St. Joe’s radiologist gave me, isn’t it? Interesting, too, that she qualified her statement with “that’s in my opinion.”

Healthgrades is a site that assesses the safety and quality of hospitals across the land. Out of curiosity, I checked on three hospitals where I might  have the threatened procedure done: John C. Lincoln, because that’s where Young Dr. Kildare practices; St. Joseph’s, because it’s a teaching hospital and it’s where my gynecologist practices; and the Mayo, because it’s the best of a generally mediocre lot here in Arizona.

In “Safety” (i.e., how likely are you to be harmed by some condition or error attributable to the hospital and its staff) Healthgrades ranks St. Joe’s below John C. Lincoln, which used to have a terrible reputation. St. Joe’s gets 7 “below average” dings, 4 “average” marks, and 2 “above average” credits, compared to JCL’s, with a mere 4 “below averages,” 3 “above averages,” and 6 “averages.” The Mayo is far superior, with 3 “below average” grades, 3 “average,” and 7 “above average.”

That’s interesting. Not to say “alarming.”

When you get into Medicare.gov…ah, that’s where it gets seriously interesting. The government has posted a lot of data about hospitals around here. One of the categories the statisticians track is “Use of Medical Imaging,” and they say that in Arizona the average rate among outpatients who have a follow-up mammogram, ultrasound, or breast MRI within 45 days of the initial screening is 8.9%. Now that may not be typical of the US overall, because there’s a lot of poverty here, and also because women who live on the Indian reservations might have a difficult time traveling back and forth for repeated exams and so might be asked less often to return. One never knows, with this place. However, on another page, the site states:

Medical evidence suggests that there may be a problem if a facility has either a very low or very high rate of follow-ups.

Although values for a very low follow-up rate have not been established, a follow-up rate near zero may indicate a facility that misses signs of cancer. Follow up rates around 9% are typical.

Research has established that a follow-up rate above 14% is not appropriate and may indicate a facility doing unnecessary follow-up.

And over at the page reporting on St. Joseph’s, we find the following:

Use of Medical Imaging:

Outpatients who had a follow-up mammogram, ultrasound, or MRI of the breast within 45 days after a screening mammogram: 16.5%. a rate higher than 14% may mean there is unnecessary follow up.

 Whoa! A return rate of 16.5 percent?? That’s almost twice the state’s average rate, and it’s 2.5 percentage points above the rate Medicare says is not appropriate. 

John C. Lincoln is better, though not great: 13.5%. It’s still very high — just a shade under the “inappropriate” level — but it’s 3 percentage points below St. Joe’s.

As for the Mayo, we’re told “Not Available; No cases met the criteria for this measure.” What on earth that means, I do not know. But I do know one may go to a local clinic of the Mayo for a mammogram, rather than having it done at the hospital per se. Maybe they’re able to claim the rate is not the Mayo Clinic’s by a little sleight of hand. In my experience, the Mayo tends to lean heavily on the panic button.

I feel like I’m on a railroad ride to Hell here…

So I’ve called Young Dr. Kildare’s office — got an appointment on the 16th. I’m going to print this stuff out and tell I want a second opinion about whether a biopsy is really necessary. IMHO it’s telling that the mammography technician stated, in no uncertain words, that the two tiny lumps were “definitely not cancer” and then all of a sudden we get a new story from someone with a vested interest in charging Medicare for an extra procedure. The tech may just have been shooting her mouth off. But…she’s in the business, too, and she must be trained to recognize, to some degree, what she’s looking at.

Unfair to the radiologist, of course.

But…in a culture where the profit motive drives delivery of medical care as well as production and delivery of pharmaceuticals, it’s hard not to be skeptical.