We’ve known that our insanely-expensive academic hospitals — very-reputable “cathedrals of medicine” — have been driving up costs at an unsustainable rate in MA.
And now we know that Mass. General has apparently been endangering its patients by double-booking surgeons for surgeries. You really need to see this email exchange between MGH administration and surgeon whistleblower, Dr. Dennis Burke.
A physician must put his patient’s interest above his own. A surgeon trying to operate on two patients at the same time serves neither well. Those who put their absolute trust in us are being deceived and put at increased risk of harm, all for economic gain.
I have spent my entire professional career at MGH, striving to provide the best possible care to patients and be an example to our surgical house staff. Our hospital has become too much about quantity, not quality. We have forgotten who we serve.
Yesterday morning you told me that I will never be forgiven. The hospital and I will be judged on the facts. But when the facts do come out, will the patients forgive those who stood by and allowed this to happen?
Sincerely yours,
Dennis
Clash in the name of care – A Boston Globe Spotlight Team Report.
This confirms long-held suspicions that MGH is a money machine first and a health provider second.
We know that people don’t shop around for cost in health care. But based on this event, people might do well to investigate alternatives to the downtown hospitals simply for their own safety.
Bob Neer says
As the Spotlight story says:
Evidence and outcomes, not emotion, should be the basis on which we evaluate health care decisions. I agree patients should be informed, but it is hasty to conclude that “MGH is a racket” when the available evidence argues the practices in question have no effect on outcomes.
merrimackguy says
and every single one was performed by an ultra-experienced, ultra-qualified physician. Each one of my outcomes was at the extreme positive end of the spectrum.
Charley on the MTA says
And I have had good experiences there. But that’s how it works, doesn’t it? You have a good experience until you don’t. Tony Meng, well, too bad for him. Quadriplegic at age 41.
What we have is a couple of those ultra-experienced, ultra-qualified physicians risking their careers to say that MGH is putting people at risk. And not just there:
And until and unless MGH releases the Stern report, how will we believe their say-so?
petr says
…I am ambivalent about the so-called ‘Stern report’… as I’m not clear why they hired a lawyer to evaluate doctors performance…
David says
that institutions often hire lawyers to conduct investigations, even if lawyers have little business investigating the subject at hand, because then the results are (in theory at least) protected by attorney-client privilege and are virtually untouchable unless the institution chooses to release them.
dave-from-hvad says
why did the surgeon, Dr. Wood, stop double-booking surgeries afterward; and, if double-booking surgeries cause no problems or complications, why did MGH “sharply limit concurrent complex spine cases” in the wake of the Meng case? The very fact that the hospital changed its policy would seem to be evidence they believe the practice either did or potentially could cause medical problems.
stomv says
(shrugs)
ryepower12 says
Let’s not make wide sweeping conclusions based on “one of the few” studies that only looked at a tiny area of what’s going on here.
And with all due respect, that study is clearly not looking at or counting the right things. It’s not just about medical errors in surgery, it’s about everything related to the interaction between patients and medical professionals — and when we’re forcing nurses and doctors to do multiple surgeries at once, we’re simply not keeping enough medical professionals on staff.
What does that mean for Massachusetts? Well, we have the fourth worst readmission rates in the entire country.
That’s what this kind of MGM frankenstein health care experimentation leads to.
Medical professionals are increasingly asked to do more and more and more. In the vast majority of cases, they’ll get the job done when it matters most, but everything else is being ‘triaged.’ Our readmission rates may not be counted as medical errors in these kinds of studies, but that’s exactly what they are — and it not only costs our system more, but results in people getting sicker or maybe even dying.
And the more and more hospitals ask, the more and more likely mistakes will happen in surgery. So many are already being pushed to the breaking point.
Another huge problem this kind of stuff causes? Retention rates and attracting people to the profession. Nurses and doctors are human beings, flesh and blood, and they’re at the breaking point. We’re losing some of the best of them because they don’t want to do it anymore — many can’t do it anymore.
New medical professionals leave the profession or leave hospitals for offices, and older medical professionals retire early. Fewer and fewer will enter health care, as they learn just how impossible the expectations of hospitals are, and that things are growing worse. This is a ticking time bomb we’re creating, and it’s our lives that are in the line of fire.
From a personal perspective, my mother is a retired nurse, so I saw what hospitals were doing to her up close and personal. It was routine that she’d come home in tears because of the number of patients she had, and she worried almost daily about her capacity to do the job safely. She was a good nurse and got the job done, but it wasn’t sustainable and she retired early, at great financial cost.
This is a disaster waiting to happen, and hospitals don’t give a damn. The medical profession changed dramatically in the past 15 years and not in a good way. It used to be about patients, and now it’s about $$$$$$$$$$.
Partners is a vast profit center, one that doesn’t pay any taxes and yet is divvying out huge quantities of money to its executive class. It makes hundreds and hundreds and hundreds of millions every year, even as it closes entire hospitals and “unprofitable” but desperately needed hospital departments, preferring to force more people to go into Boston, where they get higher insurance and medicare/medicaid payments.
For the love of all that’s holy, it’s time to rein the abuse and excess in. Partners doesn’t need to treat nurses and doctors like factory workers, and I fear for a medical system where patients are the product on the factory floor. It’s time to put patients first.
If Partners & Co. wants to call itself a non-profit, then it better freaking act like it — and Steward has proven the for-profit model is just as terrifying.
People think Massachusetts hospitals are great, and we do have the best trained and most skilled medical professionals in the world. But we do not have the best health care in the country, or world. With our readmission rates, it’s not even close to it. Until we treat nurses and doctors like humans, and patients as something beyond profits, that’s not going to change.
jconway says
As the Times pointed out, something that actually has the perverse effect of making wealthier patients sicker, but also diverts unneeded resources and physician time in a way that is patently unfair and unethical.
Single payer is the magic bullet that solves most of our health care inequity issues, it continues to be shameful that it’s a policy that is never up for serious implementation or debate in this country.
stomv says
Your red blanket (and the Times) refers to offering something like first class medical treatment to the rich.
I had thought that red blankets meant that the patient needed something more urgently, like a test. It’s a dog whistle to visually signal urgency without making the patient or the other patients aware of the prioritization.
But, not only is it that IANAL, IANAD either.
Jasiu says
I listened to a bit of On-Point yesterday (WBUR) where this was being discussed. One situation explained by the surgeon there was an example of an orthopedic procedure where the orthopedic surgeon is only needed for her/his specialty during the “meat” of the operation. So another surgeon might do the initial opening up, then the ortho comes in to do the tricky part, and this is followed by the first surgeon then finishing up while the ortho might go to the next operating room to do something similar.
That scenario doesn’t bother me. I need to read up (in my copious spare time 😉 ) on other scenarios that have been brought up (or feel free to educate me).
stomv says
I see the appeal of this, so long as everyone is on schedule.
Thing is, what happens if the orthopedic surgeon is running late because the procedure he was working on before the one you describe ran late (complications, whatev)? Does it mean that the patient in your scenario is just laying on the table, waiting around while cut open? Surely that’s not a particularly good place to be for the current patient, right?
If everyone is on schedule, it seems like this could work. My question is: what are the repercussions — both physical and emotional — if some of the moving parts fall behind schedule?
sabutai says
Don’t know much about surgery, but I imagine there are times when the patient is just going under and getting stabilized, or reverse, that the surgeon isn’t needed. It feels a bit like blaming a chef for cooking more than one dish at a time…I imagine there are stretches when the surgeon isn’t needed.
It sounds bad, yes, and I don’t know enough about it to say it’s okay…but that also means I don’t know enough to say it’s wrong.
Charley on the MTA says
One question is whether the surgeon is the planner and manager of both surgeries, or rather the one with the hyper-specialized skill for one part of the procedure. It sounds like they’re supposed to be a bit of both.
Al says
takes place is other major hospitals, too?
merrimackguy says
done a lot of your procedure/operation.
If the person has less experience and spends the whole time working on you, is that better/worse than one of these guys? I might suggest worse.
Sometimes stuff goes wrong and it’s not the doctor’s fault. Sometimes hospitals and the people in them make mistakes. We’d all like it not to happen to us/our loved ones, but it does,
This article is the Globe looking for a story. I can say right now that if I needed some major surgery, I still would be heading to MGH.
dave-from-hvad says
if you were given the following options:
1. An eminent and experienced surgeon would do the procedure, but you would be told that the surgeon would be operating concurrently on another patient as well.
2. An eminent and experienced surgeon would do the procedure, and would operate only on you.
I’m sure everyone would choose the second option. Why, because all things being equal, it’s better not to do concurrent operations. That’s what this is about, I think, and why MGH has changed its policy to prohibit concurrent spinal surgeries, as I understand the story.
I think the Globe has done a service here if only because any sane person who has to go to a hospital for surgery will certainly now at least inquire whether the surgeon is going to be working on them exclusively.
Andrei Radulescu-Banu says
Come on, Charley. MGH is not a racket. With all its faults, it is still the premier hospital in the state.
But it was dishonest for MGH not to reveal to patients the concurrent surgeries. Also, it leaves one a bitter taste in how the hospital went after the whistle blower doctor, Dennis Burke. From where I stand, Dr. Burke is a hero.
Charley on the MTA says
That anything other than patient care and safety goes into decision making and planning, is pretty appalling, and rather standard.
SomervilleTom says
We have, at least for now, chosen private for-profit health care. Even “non-profit” institutions are still measured on their ability to deliver services in exchange for money, and on the difference between their revenues and their costs.
It seems to me that this approach pretty much guarantees that a great many factors other than patient care and safety will not only go into, but often dominate decision making and planning.
I agree that it’s appalling, and lies at the heart of why the rest of the civilized world has made a different choice.
Andrei Radulescu-Banu says
> We have, at least for now, chosen private for-profit health care.
Well, let’s see if this changes. I think it should, but it is a very uphill struggle – the for-profit system is ingrained, and many hospitals & doctor offices would have to change from ground up if the system were to change.
There’s some history in the state regarding medical care price liberalization, and it’s mostly underreported. The state used to have price controls back in the ’80s or ’90s, but rather than keeping medical costs in check, the result was that many hospitals were going bankrupt.
SomervilleTom says
I remember those times quite well.
In my view, this exemplifies the need for government-sponsored single-payer health care at the federal level. States can’t do it (as you remind us), and it won’t happen so long as we value preserving health insurance industry profits above patient outcomes and reducing overall health-care spending as a share of national GDP.
As you observe, the needed change will required changing hospitals and doctor’s offices from the ground up. It will also require significant changes to our pharmaceutical industry and our prescription drug pricing mechanisms.
Donald Green says
These surgeons need a statistically valid self control. Comparing them to usual complication rates may not hold. These are top notch surgeons, and their complication rates may be significantly lower than their colleagues.
This has to matched against controls that also do this kind of surgery. Schedules would have to be designed so the surgeons do not make this decision. If there are lessor errors by the same surgeon when he does one case at a time versus two, this may mean something.
Given the ethics involved maybe past cases where there was no overlap versus overlap in the same time period could be investigated.
The other factor here is that lesser experienced surgeons are given supposedly uncomplicated tasks without one on one supervision. However a tie that is not acceptable performed or any other technique done less expertly could cause a problem. A mentor observing and doing the whole operation can intervene in a more timely way.
It is the simple things that cause disaster sometimes. A loose suture, a less than accurate equipment count, operating in the wrong space all have learned methods to avoid them. If the person most able to avoid these is present will this make a difference? The right questions have to be asked.