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2.2. I'm researching your HLHS claim. I do know the HLHS surgeries per se are performed locally often.
There was a recent period (during 2017 I believe) that Children's was unable to perform these surgeries and closed down their CICU for 6 months. This was because both pediatric cardiac surgeons left the same week. Our pediatrician was actually the one who told me this--he and his wife are associated with Children's and are part of their pediatric residency program, so I believe them. Additionally, I told my husband this and he knew the names of the two docs (they were big deals). We looked it up and both have moved onto different places. The fact that they both left concurrently was a sign that something went down.
Since then, they have hired new people, but obviously recruiting such a sub-specialized surgical specialty takes a long time and patients were having to be referred elsewhere during that period.
I would trust Children's to care for my critically ill child 100% (and my husband has done and will do much of his training there), but Texas Children's in Houston really is the superior hospital.
My mother is treated by some UTSW doctors and is very happy with her care. She’s very choosy about her doctors to. How affiliated currently are the Baylor Scott and White hospitals with the Baylor medical school? I know my parents go to their dental school in Dallas.
Your mother might be getting the best care in the world and without knowing her ailment or disease, doctor, and treatment no one can say it is the case or isn't. The fact that she is happy means something but I can tell you some of the issues with the teaching institutions.
1) These are teaching institutions which means they need to do procedures that they are teaching to med students. The issue here is that there are many procedures that are more in line with private practices that are simply not performed at teaching institutions so a person would not get the option of having one of these procedures. Many times these procedures are better for the patient than the offering of a UTSW.
2) Again because these are teaching institutions the procedures that are performed are not done as well as private counterparts. One reason could be that you might think that your world class teaching doctor is doing the procedure but quite often a medical student is performing some of that procedure. Using a hip replacement for example it is possible that because the ortho doc has to teach a medical student he has to make a 8-12 inch incision instead of a 4 inch incision that a private doctor (not affiliated with UTSW) might do. On my next point I'll discuss more but a UTSW doc is more limited as to what he can use so he might use an actual hip that is not necessarily the best choice for the patient based on anatomy which could limit range of motion, etc. Both go down as 100% successful procedures but one patient might have a smaller incision and a great range of motion.
3) This leads to my next point. Mass amounts of money from manufacturers pour into these facilities which leads to single manufacturers owning the products being used. You might get an Ethicon product that is used on you instead of a better Covidien product (or vice versa) because of the contracts and/or amounts of money that sway the decision. While it happens at private facilities (non teaching) there tend to be more leniency as to what is and is not used
4) . Piggybacking off point 3 there are also mass amounts of money being directed to physicians at teaching institutions. The Sunshine Act shows transparency if money is paid to a doctor at Parkland (for example). Whereas up to 10x as much might be given at UTSW and since it is paid for research to the Institution or paid to do a study the transparency is lost. It only shows up as being given to UTSW even though a specific doctor or specialty might use 90% of the money.
5) Many studies are done at teaching institutions and huge amounts of money go into these studies and if a study is performed at UTSW and you go in to see a physician with an ailment that the study is being done on you can almost bet anything that you will be getting that procedure done.
I remember specifically at UTSW a certain procedure was being done on patients that worked very well for the right patients and was being done consistently at close to the same number each year which makes sense. A few years ago it went to 0 being done. I began to look into it (as I consult across the nation with various hospitals) and wondered why it went from being done often to not at all. Come to find out one of the doctors wanted a grant paid for by the manufacturer and when they refused to pay the amount the doctor wanted he got the whole department to stop doing the procedure. Sucks for the patients as many had a surgery done that was not necessary because of this.
There is a darker side to medicine that many do not know about. I can tell more and more stories. Some flat out sound like fiction.
Your mother might be getting the best care in the world and without knowing her ailment or disease, doctor, and treatment no one can say it is the case or isn't. The fact that she is happy means something but I can tell you some of the issues with the teaching institutions.
1) These are teaching institutions which means they need to do procedures that they are teaching to med students. The issue here is that there are many procedures that are more in line with private practices that are simply not performed at teaching institutions so a person would not get the option of having one of these procedures. Many times these procedures are better for the patient than the offering of a UTSW.
2) Again because these are teaching institutions the procedures that are performed are not done as well as private counterparts. One reason could be that you might think that your world class teaching doctor is doing the procedure but quite often a medical student is performing some of that procedure. Using a hip replacement for example it is possible that because the ortho doc has to teach a medical student he has to make a 8-12 inch incision instead of a 4 inch incision that a private doctor (not affiliated with UTSW) might do. On my next point I'll discuss more but a UTSW doc is more limited as to what he can use so he might use an actual hip that is not necessarily the best choice for the patient based on anatomy which could limit range of motion, etc. Both go down as 100% successful procedures but one patient might have a smaller incision and a great range of motion.
3) This leads to my next point. Mass amounts of money from manufacturers pour into these facilities which leads to single manufacturers owning the products being used. You might get an Ethicon product that is used on you instead of a better Covidien product (or vice versa) because of the contracts and/or amounts of money that sway the decision. While it happens at private facilities (non teaching) there tend to be more leniency as to what is and is not used
4) . Piggybacking off point 3 there are also mass amounts of money being directed to physicians at teaching institutions. The Sunshine Act shows transparency if money is paid to a doctor at Parkland (for example). Whereas up to 10x as much might be given at UTSW and since it is paid for research to the Institution or paid to do a study the transparency is lost. It only shows up as being given to UTSW even though a specific doctor or specialty might use 90% of the money.
5) Many studies are done at teaching institutions and huge amounts of money go into these studies and if a study is performed at UTSW and you go in to see a physician with an ailment that the study is being done on you can almost bet anything that you will be getting that procedure done.
I remember specifically at UTSW a certain procedure was being done on patients that worked very well for the right patients and was being done consistently at close to the same number each year which makes sense. A few years ago it went to 0 being done. I began to look into it (as I consult across the nation with various hospitals) and wondered why it went from being done often to not at all. Come to find out one of the doctors wanted a grant paid for by the manufacturer and when they refused to pay the amount the doctor wanted he got the whole department to stop doing the procedure. Sucks for the patients as many had a surgery done that was not necessary because of this.
There is a darker side to medicine that many do not know about. I can tell more and more stories. Some flat out sound like fiction.
Except there isn't, since I deal with this process pretty much everyday and specifically with UTSW among others. I would love for you to point out which are specifically wrong. BTW non teaching institutions have their issues as well but they are different issues.
I work with more medical institutions in a year than anyone you know does in their lifetime. I get paid to do this for a living.
ETA: I get it now. A doctor who graduated from UTSW that doesn't want what goes on exposed. Typical. Sorry the truth hurts.
Except there isn't, since I deal with this process pretty much everyday and specifically with UTSW among others. I would love for you to point out which are specifically wrong. BTW non teaching institutions have their issues as well but they are different issues.
I work with more medical institutions in a year than anyone you know does in their lifetime. I get paid to do this for a living.
ETA: I get it now. A doctor who graduated from UTSW that doesn't want what goes on exposed. Typical. Sorry the truth hurts.
Every institution has different setup, it can be vastly different even among peer institutions. Within an institution, each specialty is also very different in term of financial arrangement, some are salaried while other are independent.
Do you actually do consult for UTSW and know about their specific cases? If not, you are not qualified to comment about UTSW.
1. Generally, doctors at teaching institutions are salaried (generally, not 100%). So they are less inclined to recommend expensive or unnecessary procedure to pad their pockets. Most large institutions also have very strict conflicts of interest and financial disclosure.
2. No attending would/should ever alter the procedure to show/teach medical students. Your comment show your very basic understanding.
3. Medical students only perform very basic procedures and always under strict supervision. Patients are always asked if they allowed medical student to learn. And patient can always refuse to let medical students see them.
Every institution has different setup, it can be vastly different even among peer institutions. Within an institution, each specialty is also very different in term of financial arrangement, some are salaried while other are independent.
Do you actually do consult for UTSW and know about their specific cases? If not, you are not qualified to comment about UTSW.
1. Generally, doctors at teaching institutions are salaried (generally, not 100%). So they are less inclined to recommend expensive or unnecessary procedure to pad their pockets. Most large institutions also have very strict conflicts of interest and financial disclosure.
2. No attending would/should ever alter the procedure to show/teach medical students. Your comment show your very basic understanding.
3. Medical students only perform very basic procedures and always under strict supervision. Patients are always asked if they allowed medical student to learn. And patient can always refuse to let medical students see them.
To your points.
Yes I do consult at UTSW and know about their specific cases, caseload, financial arrangements, books, etc.
Totally agree that each physician is very different. Totally agree that not every physician is getting paid by someone. Certainly not the case and if I insinuated that I apologize. It is literally impossible for a person to know if Doctor A is getting paid by company A while Doctor B gets nothing. I certainly did not mean to imply they would recommend an expensive surgery for financial reasons. What I have seen (specifically at UTSW) is that they have recommended a surgical procedure because what is offered at UTSW is all that is left. For example there might be an ailment done in the private sector (non teaching) where the workup for that ailment is treatment A, then B, then C, then D, then E, where D and E are surgical in an OR. At UTSW they do A, but they don't offer B or C so they have to go to D if A does not work. This is very common. I have seen it with Urology and Gynecology many times. I have met with non teaching doctors in Dallas where UTSW recommended D or E where I told a physician that based on the data, anatomy, and symptoms B or C would likely work. I definitely agree that D or E recommended at UTSW was not for financial reasons.
I also agree that most at teaching institutions are salaried which is less of a conflict than non teaching doctors, but do have goals that non teaching doctors likely do not have when it comes to studies, research, etc.
Never seen an attending alter a procedure, but very few attendees are doing total hips with 4 inch incisions and the docs that do those are very likely not at a teaching institution. As for the limitations on what hip is being used that is certainly not the doctor's fault. That is an institution issue and one I deal with often.
Medical students are at various stages in procedures. I have seen some perform on the acetabulum (for example), while others are not quite there yet and might only get to close, etc. They are always supervised, but what I can tell you is that while signing all those consent forms most patients don't realize one of them is that a medical student might be doing something. I am certainly grateful that they do and can since they have to learn somewhere, but it isn't going to be on me or my family.
While I have specific experience at UTSW and many other teaching institutions these are issues at almost every single teaching institution I have ever been to so this certainly is not just a UTSW issue. I consult at UTSW, LSU, Stanford, UCLA, Scripps, UCSF, Texas Tech, OU, the VA, Kaiser, and many private facilities that number in the hundreds. We do about $300M a year in consulting fees (revenue) as a company so that gives you the scope of the amount of business being done. We are not close to the biggest in the US. Some follow a lot of advice, some follow a little, and some follow none.
There was a recent period (during 2017 I believe) that Children's was unable to perform these surgeries and closed down their CICU for 6 months. This was because both pediatric cardiac surgeons left the same week. Our pediatrician was actually the one who told me this--he and his wife are associated with Children's and are part of their pediatric residency program, so I believe them. Additionally, I told my husband this and he knew the names of the two docs (they were big deals). We looked it up and both have moved onto different places. The fact that they both left concurrently was a sign that something went down.
Since then, they have hired new people, but obviously recruiting such a sub-specialized surgical specialty takes a long time and patients were having to be referred elsewhere during that period.
I would trust Children's to care for my critically ill child 100% (and my husband has done and will do much of his training there), but Texas Children's in Houston really is the superior hospital.
But boy to your other points! Academic medicine isn't perfect, but it isn't the ****show you are describing above.
Quote:
What I have seen (specifically at UTSW) is that they have recommended a surgical procedure because what is offered at UTSW is all that is left. For example there might be an ailment done in the private sector (non teaching) where the workup for that ailment is treatment A, then B, then C, then D, then E, where D and E are surgical in an OR. At UTSW they do A, but they don't offer B or C so they have to go to D if A does not work. This is very common. I have seen it with Urology and Gynecology many times.
Academic institutions are literally where new procedures and techniques are created and taught!
Oh this one is good. I have a friend that just had a procedure done at UTSW to help with postpartum (like after multiple kids) incontinence. The procedure they did to help is not offered many places. The next step is a procedure that literally isn't offered anywhere else (involves stabilizes the bladder without the use of mesh). She is moving right now and cant do the recovery time, but is considering coming back here to have it because they don't perform it anywhere else.
Or a few years ago my grandfather needed mitral valve repair. He was not a good candidate for open heart surgery. That's all his surgeon in the Phoenix suburbs was offering. My husband had heard of the minimally invasive mitraclip procedure and we literally considered flying him here for it--only a few institutions in the country had surgeons that offered it at that point. Luckily someone in Arizona started offering it soon after we started looking (at their teaching hospital!!!) and he was able to get it there.
There's nothing wrong with private practice physicians. My husband will likely be one himself. However, the reality is that you are more likely to end up with an "ok but not the best" approach or procedure in a non-academic setting with a physician that does it the way he learned 10 years ago and that's it. That's not always true, but it is an inevitability when research isn't part of your daily practice. Academic institutions are where the experts in the field reside. I can tell you that if I ever had a serious issue, I'd be at UTSW first.
Quote:
Piggybacking off point 3 there are also mass amounts of money being directed to physicians at teaching institutions. The Sunshine Act shows transparency if money is paid to a doctor at Parkland (for example). Whereas up to 10x as much might be given at UTSW and since it is paid for research to the Institution or paid to do a study the transparency is lost. It only shows up as being given to UTSW even though a specific doctor or specialty might use 90% of the money.
Physicians have to disclose any sort of conflict of interest or payment in excruciating detail, especially if they are on the academic side. In every presentation. At the beginning of every talk.
But boy to your other points! Academic medicine isn't perfect, but it isn't the ****show you are describing above.
Academic institutions are literally where new procedures and techniques are created and taught!
Oh this one is good. I have a friend that just had a procedure done at UTSW to help with postpartum (like after multiple kids) incontinence. The procedure they did to help is not offered many places. The next step is a procedure that literally isn't offered anywhere else (involves stabilizes the bladder without the use of mesh). She is moving right now and cant do the recovery time, but is considering coming back here to have it because they don't perform it anywhere else.
Or a few years ago my grandfather needed mitral valve repair. He was not a good candidate for open heart surgery. That's all his surgeon in the Phoenix suburbs was offering. My husband had heard of the minimally invasive mitraclip procedure and we literally considered flying him here for it--only a few institutions in the country had surgeons that offered it at that point. Luckily someone in Arizona started offering it soon after we started looking (at their teaching hospital!!!) and he was able to get it there.
There's nothing wrong with private practice physicians. My husband will likely be one himself. However, the reality is that you are more likely to end up with an "ok but not the best" approach or procedure in a non-academic setting with a physician that does it the way he learned 10 years ago and that's it. That's not always true, but it is an inevitability when research isn't part of your daily practice. Academic institutions are where the experts in the field reside. I can tell you that if I ever had a serious issue, I'd be at UTSW first.
Physicians have to disclose any sort of conflict of interest or payment in excruciating detail, especially if they are on the academic side. In every presentation. At the beginning of every talk.
For the record I'm the guy who brought up Mendeloff, however, I'm not the guy slamming academic medicine.
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