There is a very good article in the NYTimes about whether doctors should inform patients about disparities in care between hospitals:
An article published online in October
in the journal PLoS Medicine really hit home with me. Noting that the
quality of cancer care is uneven, its authors argued that as part of
the informed-consent process, doctors have an ethical obligation to
tell patients if they are more likely to survive, be cured, live longer
or avoid complications by going to Hospital A instead of Hospital B.
And that obligation holds even if the doctor happens to work at
Hospital B, and revealing the truth might mean patients will take their
business someplace else.
"It's only fair," said Dr. Leonidas G.
Koniaris, an author of the article and a cancer surgeon at the Miller
School of Medicine at the University of Miami.Studies
have confirmed the common-sense notion that practice makes perfect, and
the medical profession has known for at least 30 years that how well
people fare after surgery often depends on where it was performed. For
a given operation, outcomes are generally best at "high volume" hospitals,
which perform it often. The difference between high- and low-volume
centers is not just the surgeon's skill, but also the level of
expertise in other areas that are crucial after surgery, like nursing,
intensive care, respiratory therapy and rehabilitation, Dr. Koniaris
said. The same principles apply to treating cancer.But patients
are not often told during the informed-consent process that the results
of cancer treatment can vary among hospitals, according to Dr. Koniaris
and his co-author, Nadine Housri, a medical student.
"I think it's sort of starting to happen but hasn't really become a dialogue yet," Dr. Koniaris said. (Links in original.)
I absolutely agree, but I don't think it should just be limited to
things like cancer. From the point of view of a neurologist there are
a lot of rare diseases of there that you may never have had experience
treating. Or there maybe diseases that having a lot of practice does
make a difference. The one that springs to mind is Multiple
Sclerosis. If I had a patient that we identified with MS, I would tell
them that I would be happy to treat them but that they would probably
recieve better care from someone who spends all day and all night
treating the disease.
This sort of informed consent does not need to be adversarial; it is
just admitting your strengths and weaknesses. Nor does it necessarily
imply that patients will only be treated by ultra-specialists. Lots of
patients will feel more comfortable being treated by their primary care
physician because they have developed a rapport with that person. Lots
of patients will want to stay at a nearby hospital rather than travel
long distances to go to a teaching hospital.
I don't think that patients having more information and therefore
more realistic expectations about their treatment is ever a bad thing.
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What's scary is that I'm used to seeing this in other fields (including one recent referral from a home remodeler, and I know they're hungry right now) and have worked for several electronics companies which would refer customers to competitors if they were a better fit.
Why scary? Because the thought of encountering the same treatment in medicine never occurred to me, and I'm closer to 60 than to 50.
ER doctors that I know do this all the time, especially between MDs and EMTs who bring random trauma cases to non-trauma hospitals. We also frequently transfer people to other hospitals to provide what EMTALA calls a "higher level of care", in other words we don't do that well here.
This is not economic triage but prudent use of statute to allow us to avoid the ugly truth that all hospitals are not equal. When care can be had and the on call MD doesn't want the case because that MD doesn't feel they have the expertise, then the same process occurs (a transfer of care elsewhere) but with less certainty that the EMTALA rules have not been violated.
Ideally this should just be common business practice, for any business in an area where (niche) technical expertise is required. My opinion is that if politics and profits come first, then, in the long run, everyone loses. Jobs should really be a "fit" between what is needed by the client and what can be offered by the provider. As your article points out, the more information the client has, the more able they are to make a correct decision that fits their needs.
Done openly it can benefit everyone, as long as everyone passes "less appropriate" clients on to businesses that are a better fit to the clients' needs. It has to work both ways, though and that can be a (mental) stumbling block for some players.
I work as an independent bioinformatics (computational biology) consultant serving companies and research teams and I sometimes am in a position to do the equivalent. For example, my background background in plant biology is limited to undergraduate level. Projects using that background may want too look elsewhere. If I advise people this, they can decide if they are willing to accept the almost certainly greater overheads than working with a plant specialist, if one is available. They may still prefer to work with me, based on my longer track record and particular expertise, but at least they have the information needed to make their decision and it's their call as I feel it should be. By contrast, it can be frustrating to watch teams using computational biologists with little expertise in protein structures, functions and evolution, or higher level control of gene expression in eukaryotes on projects that would benefit from this background, and not thinking to pass the work on. I'm sure medical specialists must get similar frustrations.
Perhaps a point of difference is that medics, in general, have a better sense of "care of duty" to their clients than business in general?