No. of Recommendations: 158
All METARs are keenly interested in risks and outcomes.

This is especially true when your life is at stake.

Should Informed Consent for Cancer Treatment Include a Discussion about Hospital Outcome Disparities?

Nadine Housri, Robert J. Weil, David I. Shalowitz, Leonidas G. Koniaris

Background to the debate: Several studies have found disparities in the outcome of medical procedures across different hospitals — better outcomes have been associated with higher procedure volume. ...

[Many] studies have found an association between improved outcome and high hospital procedure volume or teaching hospital status...
[end quote]

The U.S. government has provided a web site where hospital outcomes are compared. This excellent web site allows you to search for hospitals, and compare hospital ratings for important measures of care (e.g. whether antibiotics and pain control are administered at the right time)...and also compare prices for the same type of operation.

This has personal significance for me.

About a month ago, an ultrasound detected a solid ovarian tumor. It is unclear yet whether it is malignant or benign. Biopsy is necessary.

My small-town gynecologist offered to biopsy the ovary in our remote area's small hospital, and send me to an oncologist if it is malignant.

METARs probably know me well enough by now to know that the suspicion of ovarian cancer set me off on a major literature search. That's why I haven't been as active on the board lately.

The National Library of Medicine contains several reports that ovarian biopsy can actually spread cancer rapidly around the abdominal cavity (fatal), if biopsy of the malignant ovary is done by a general surgeon at a local hospital, rather than an experienced oncological surgeon, who can properly encapsulate the ovary during removal, stage the cancer and remove affected lymph nodes and metastases at the same time as the biopsy.

One study found the survival rate advantage was 25% (at 5 years) between women whose malignant ovaries were biopsied at a regional cancer center versus at a local, non-specialty hospital.

I feel that it was unethical and irresponsible for the local gynecologist to offer to biopsy my ovary.

With my life at stake, I said, "Do not pass GO, do not collect $200 -- go directly to the best gynecological oncologist in my state."

I am going to a gynecological oncologist with 20 years of experience, at a cancer specialty practice which is about 3 hours away from home. The Hospital Compare website rates the hospital favorably on important patient care factors, compared with other hospitals in the Seattle area.

I will be having a major operation next week. Given the variables, the probability of my condition being benign is about 33%. If it is ovarian cancer ... well ... the bright side is that it was probably caught relatively early.

I want to give sincere and heartfelt thanks to Doctor Optimist, who has been a tremendous help to me, privately giving me advice and helping me to interpret the information.

For obvious reasons, I will be away from METAR for a while. I hope and trust that the many fine participants on METAR will maintain this board as the information-rich, politics-free zone that makes this the most popular investing-oriented board on TMF.

Wishing you all a happy, healthy and prosperous New Year,

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