By Lisa Esposito
If you suffer from a serious chronic illness, or you need major but elective surgery: Are you better served by the familiar hospital right down the road or the prominent medical center 90 miles away? See what experts in lung disease, heart conditions, cancer and orthopedics say about when your local hospital is a perfectly good option for routine procedures and when to seek the next level of care from an academic medical center, a major hospital system or a specialty center.
Joint Surgery Selections
Total hip replacements and knee replacements are among the most commonly performed surgeries in the U.S. and can very well be done in a community hospital versus a world-renowned orthopedics facility, says Dr. Alexandra Page, an orthopedic surgeon in a private practice in San Diego. Access is a big part of the equation, Page says – a highly acclaimed hospital center is no help to a patient if it’s unattainable due to distance or insurance coverage issues.
When considering high-tech treatments only available at certain centers instead of standard therapy, Page says, you should avoid being the first patient to undergo a procedure – but never be the last one to have it, either. Be ready to move on when a practice is outdated, she advises. However, she adds, “Some of the other things that sound sexy and appealing, trying to generate buzz, often don’t make a difference.” With robotic joint replacement, for instance, she says the research literature is “borderline at best.”
But there are times when specialty centers make sense. With musculoskeletal tumors, like breast cancer that’s spread to the bones, it’s important a specialist handles it, Page says. Similarly, community hospitals may not have the resources for complicated joint surgeries such as complex revisions for deep infections or worn-out implants. Orthopedic surgeons know when to refer patients onward, if their facility doesn’t perform a procedure often enough or specialized equipment isn’t available.
“In commonly occurring diseases, and commonly occurring problems, we’ve got pretty good data to show that a community hospital and community doctor can do a very good job handling those things,” says Dr. Otis Brawley , chief medical officer for the American Cancer Society. “And indeed, sometimes, can do a better job than a tertiary care facility.”
For example, Brawley says, a woman with early-stage breast cancer receiving standard chemotherapiesAdriamycin and Cytoxan might do better locally. “If you go to a large university hospital or cancer center that employs 80 chemotherapy nurses – they give it, but they may not give it as often,” Brawley says. Instead, those nurses are giving a wide variety of chemotherapies to many more patients.