One out of nine or 10 of us, depending on age, will be admitted to a hospital sometime this year.
Not all hospitals, however, are equal. Which hospital, what kind of hospital should we go to?
Our doctor, it is true, usually picks the hospital for us. If we trust the doctor, we probably just go.
But many doctors practice at more than one hospital and are willing to discuss the matter with their patients. When picking a doctor, you can ask: What hospital or hospitals do you practice at? Many of the best doctors, not all, have a university teaching hospital affiliation, and spend at least some of their patients there.
And some community hospitals have higher standards and attract better doctors than others. Ask your doctor why the choice of a particular hospital -- and ask anyone else you think may be helpful. Ask doctors where they or their families have been hospitalized. Ask nurses.
A basic choice, often, is whether to go to a large university or university-affiliated teaching hospital or a community hospital. Teaching hospitals swarm with "house staff": interns and other residents in three to five or more years of specialized training. Many community hospitals have at least some residents. If they have enough, there is a better chance that there may be an MD to help if you take a sudden turn for the worse at 3 a.m.
In a community hospital, your own doctor is likely to be most responsible for your treatment. The whole place may be quieter and friendlier because many of the patients are not as sick and the nurses not quite as busy.
In a major teaching hospital, the house staff writes the orders for your care, and your doctor -- if involved at all -- may be only a kind of monitor who may be able to change the orders in case of disagreement. And your care may involve a swarm of doctors -- interns, residents, attending physicians (perhaps including your doctor) and the faculty doctors, who supervise the whole show. The process may save your life, but you may feel more like a subject than somebody's patient.
Studies show that patients are generally more satisfied in smaller hospitals. But they also show that the busier the hospital, the likelier it is that its staff has had a lot of experience with complicated problems. Experience counts in getting good outcomes and minimizing deaths from infections and surgery.
Many hospitals specialize in certain areas. Ask: What hospital, what surgeon, what specialist has the most experience with my condition? And if some other hospital seems better for you, you may want to say: "Please refer me to a doctor who practices there."
It's your life.
What do we know about Washington area hospitals?
Not enough. We, the public, know little or nothing about hospitals' death rates, complication rates, hospital-acquired infection rates and other measures of hospital quality.
By a new federal regulation, the public should soon have access to such facts, now being gathered by "PROs" -- Professional Review Organizations created by Congress to monitor hospital treatment of Medicare patients but also tracking hospitals' broader performance. Each PRO must now establish a procedure by which any group, agency or individual can ask for specific statistics about either hospital performance or the performance of any group of doctors (though not individual doctors).
When such figures -- say, heart surgery death rates -- are released they will require interpretation. Large university and teaching hospitals commonly care for sicker, more vulnerable patients than smaller community hospitals. They may have higher death and infection rates, yet have highly skilled staffs giving superior care.
So figures alone may not tell the whole story. There is often no perfect way to judge hospitals. But one way to reach some helpful judgments is to ask persons in the medical world how they rate hospitals.
There have been some such limited assessments of Washington area and some nearby hospitals:
* Johns Hopkins Hospital in Baltimore, an hour's drive from downtown Washington, is consistently listed as one of the nation's "top 10" hospitals by writers or magazines compiling such lists.
* The Medical College of Virginia Hospitals in Richmond made one recent "top 20" listing. Many Virginia doctors think the University of Virginia Hospitals in Richmond are actually that state's -- and among the nation's -- best.
* The only Washington hospital consistently on such "best" lists is Children's Hospital National Medical Center. Many doctors think it is Washington's finest hospital. Many area hospitals with pediatric wards regularly transfer very sick youngsters to Children's.
* Another specialized hospital here that gets high marks, though not Children's national rating, is Columbia Hospital for Women, a small but excellent obstetrics-gynecology hospital that is a teaching hospital for Georgetown University.
* The rest of the area's medical and surgical hospitals -- around 30, depending on how widely you define the "Washington area" -- consist of:
* Three university "teaching hospitals" where large numbers of interns and other residents give a large share of the care: George Washington University (GW), Georgetown University and Howard University hospitals.
* Three main public (local government-owned) hospitals: D.C. General Hospital, a major teaching hospital for Georgetown and Howard Universities, and the two-hospital system of Prince George's General Hospital in Cheverly and Greater Laurel Beltsville Hospital, Lanham.
* The Washington Hospital Center, a large non-university hospital with university affiliations.
* Four major federal hospitals: the outstanding National Institutes of Health Clinical Center in Bethesda -- a good place to be if you fit into their research and are willing to be "randomized" into what may be one of several study groups getting different treatments -- and three military hospitals, Malcolm Grow Air Force Medical Center at Andrews Air Force Base, the National Naval Medical Center in Bethesda and Walter Reed Army Medical Center. The military hospitals have staffs generally well rated,despite some recent exceptions.
* Community hospitals ranging from the large, well regarded Fairfax Hospital system -- Fairfax Hospital in Falls Church, Mount Vernon Hospital in Alexandria and other specialized units -- to 30-bed Clinton Community Hospital in Clinton.
In 1980 the nonprofit Washington Consumers' Checkbook asked 349 area nurses to rate area hospitals. Listing those rated by at least eight nurses, the Checkbook gave "top overall" medical care ratings to:
* The District's Children's, Columbia, GW, Georgetown and Sibley hospitals and the Washington Hospital Center.
* Suburban Maryland's Holy Cross and Washington Adventist hospitals.
* Northern Virginia's Fairfax Hospital.
Last year Washingtonian magazine medical writer John Pekkanen interviewed more than 30 area emergency physicians and rated area hospital trauma centers and emergency departments, partly by considering the overall quality of the hospital and its staff.
Among trauma centers, special units where the most seriously injured patients should be treated:
* Three in Washington -- Children's, GW and the Washington Hospital Center -- and the University of Maryland's famed shock trauma unit in Baltimore -- were called "outstanding."
* Prince George's General Hospital and Suburban Hospital were called "very good."
* Alexandria, Arlington, Fairfax, Georgetown and Greater Southeast Community hospitals were called "good."
* D.C. General and Howard were called "fair."
Area hospitals' more traditional emergency rooms got these ratings (some were not rated because they were not known well enough by doctors surveyed):
* "Outstanding": Children's, Prince George's County Doctors', Georgetown, GW and Holy Cross hospitals.
* "Very good": Arlington, Greater Southeast Community, Montgomery General and National Orthopaedics and Rehabilitation Hospital.
* "Good": Alexandria, Greater Laurel Beltsville, Mount Vernon, Northern Virginia Doctors', Shady Grove Adventist, Suburban and Washington Hospital Center.
* "Good to fair": Capitol Hill, Fairfax, Sibley and Washington Adventist.
* "Fair": Commonwealth, D.C. General, Hadley, Howard, Jefferson, Leland, Prince George's General, Providence and Southern Maryland.
These are all unscientific surveys, and some of these hospitals and emergency rooms have been undergoing change and upgrading.
There is one more way to judge hospitals, especially if your condition is life-threatening. You may want to be in a teaching hospital with adequate numbers of medical and surgical interns and other residents around at all hours.
The leaders here (not counting the generally adequate federal hospitals):
* GW, with 390 residents, including 217 in medical and surgical services, 36 in OB-GYN and 66 in pediatrics (who mainly make up the house staff at affiliated Children's Hospital).
* Georgetown, 349 (222 medical and surgical, 32 in OB-GYN, 36 in pediatrics and seven in neonatology).
* Howard, 298 (173 medical and surgical, 24 in OB-GYN, 37 in pediatrics).
* D.C. General, 74 in medical services. D.C. General is also staffed by Georgetown and Howard residents.
* Washington Hospital Center, 153 residents (112 in medical and surgical, 16 in OB-GYN). The center has affiliations with GW and Georgetown by which their residents spend time there.
Other hospitals with approved residencies or medical school affiliations that provide them some residents (a "major" affiliation means the school uses the hospital as a main teaching center):
* Arlington, major affiliation with Georgetown in surgery and pediatrics.
* Fairfax, 18 family practice residencies and five in pathology and laboratory medicine, plus a major affiliation with Georgetown and affiliations with GW and Medical College of Virginia in several medical and surgical specialties, OB-GYN and pediatrics.
* Greater Southeast Community, major affiliation with Howard in surgery and OB-GYN.
* Holy Cross, major affiliation with GW in surgery and OB-GYN.
* Prince George's General, 12 family practice residencies, 14 in surgery and 10 in OB-GYN, plus a major affiliation with the University of Maryland in medicine, surgery and OB-GYN.
* Providence, with 16 medical and eight OB-GYN residencies and affiliations with GW, Georgetown and Howard in medicine, OB-GYN and orthopedic surgery.
* Sibley, major affiliation with Georgetown in several surgical specialties.
* Suburban, major affiliation with Georgetown and an affiliation with the University of Maryland in some surgical specialties.
Where would I go if I needed hospital care? I'd ask my doctor, whom I trust. But if the condition were serious, I might, he knows, seek some other opinions too, then make up my mind.
In some emergencies, it should be emphasized -- and this includes a possible heart attack -- the "best" place to go is usually the nearest adequate one. Emergency crews -- those who respond to 911 calls -- are instructed to take you to the nearest available qualified hospital. Otherwise you might die on your way to the one you "choose."