When relatives or friends are facing a medical issue, I'll often get a call. Sometimes it's to ask my advice. But more often than not, the issue is not in my field and so the question is: "Who is the best oncologist/gynecologist/fill-in-the-blank.
So when I read this article in the New York Times by Dr. Emanuel, building off a similar experience -- I was curious. He looked at a study done in JAMA that looked at tens of thousands of hospital admissions, and concluded that when top-ranking cardiologists were out of town, patients back at their home hospitals had better results than when the famous and more experienced cardiologists were there to provide care.
In other words, the best cardiologists provided not-as-good care.
As someone who values experience, skill, and expertise, my first instinct was to be a little annoyed or dismissive of the article. Just one more thing to degrade the value of valuable professionals. But the more I thought about it, the more I realized that the point isn't so much that the experienced cardiologists aren't good. I'm sure they're exceptional.
To me, the point is that we overestimate the ability of a single provider to be extraordinary. When relatives ask for the "best oncologist" maybe they would be better off asking a more long-winded question like, "What do you think would be the best medical context and team for me to get treatment, heal, and thrive, within my life and parameters?"
Excellent medical care is an extraordinary thing. It involves deep caring, innovative medicine. It involves deep skill and experience. It also requires a team that is able to work together effectively. That requires more than just smart doctors -- it requires:
- Treatment that disrupts the patient's life as little as possible and so is close to home and in a familiar setting.
- A medical team that has the healthcare collaboration tools (and leeway / freedom) it needs to work together effectively.
- Communication tools (like telemedicine) that allow providers across the continuum of care to collaborate on cases from their unique perspectives and using their unique skills.
- Administration that respects the contributions of each medical provider and allows the flexibility, time, and resources for them to do their work.
- A patient who is invested in the care plan and doing their part to make it successful.
Good care requires good doctors -- but it requires a team of good doctors -- not a lone expert.
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