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"Get me the best cardiologist" is our natural response to any heart problem. Unfortunately, it is probably wrong. Surprisingly, the right question is almost its exact opposite: At which hospital are all the famous, senior cardiologists away?
One of the more surprising — and genuinely scary — research papers published recently appeared in JAMA Internal Medicine. It examined 10 years of data involving tens of thousands of hospital admissions. It found that patients with acute, life-threatening cardiac conditions did better when the senior cardiologists were out of town. And this was at the best hospitals in the United States, our academic teaching hospitals. As the article concludes, high-risk patients with heart failure and cardiac arrest, hospitalized in teaching hospitals, had lower 30-day mortality when cardiologists were away from the hospital attending national cardiology meetings. And the differences were not trivial — mortality decreased by about a third for some patients when those top doctors were away.
Truly shocking and counterintuitive: Not having the country's famous senior heart doctors caring for you might increase your chance of surviving a cardiac arrest.
Comment: A recent review published in the Journal of the American Medical Association found that many commonly employed medical procedures, to which millions are subjected to each year, are based on questionable and in some cases, non-existent evidence. Market forces (i.e. profit incentives) rather than scientific evidence are being used to determine the standard of care. Interestingly, a 2008 study conducted by Emory University revealed that physician strikes are associated with reduced mortality.