It's time to level the playing field

Last week, my third newly-diagnosed colon cancer patient of the year cancelled her appointment to see the community surgeon I had referred her to. Instead, she asked her family physician to refer her to a surgeon at a university teaching centre. She said she believed she had a better chance of surviving if she received surgery there.

I hope she does well. Is this an unreasonable attitude on her part — Perhaps not. As a resident of the Greater Toronto area, my home is inundated with solicitations to donate money to the academic teaching centres. One I received recently suggested that a certain academic centre provided the "best" medicine with the "best" doctors. I'm sure that most of my patients receive the same solicitations. The implications of this are obvious. If the "best" medical care is provided at that hospital, perhaps the medical care provided at other hospitals is not equal and therefore the healthcare consumer, given the choice, should go to that centre for care.

In my opinion, academic centres, such as the one sponsoring this most recent mass mailing, have long believed that they provide superior care. As a medical resident, expressions such as "always be afraid of a consult coming from a city that starts with the letter ____" or "look out for the Friday afternoon punt from ____" were freely expressed, both by house staff and attending physicians. A colleague once told me the story of how, when he announced to his mentor that he had accepted a non-academic position, he was told that he "could go down the ladder but couldn't go back up again."

It's time to acknowledge that we're all part of the same team. If centres claim in large volume mailing that they provide the "best" medicine, they should be willing to provide the data to support this claim. Having worked in both environments, I can attest to the fact that there are many excellent physicians at community hospitals, and many mediocre ones at academic centres. The problem is that most patients won't be able to tell the difference, at least initially, or until it's too late.

If there are areas of substandard care in the community, measures need to be taken to identify and correct deficiencies. This likewise applies to academic centres which, rather than resting on their laurels, have to acknowledge and correct areas where they have deficiencies. Most importantly, the patient needs to be confident that, regardless of where he or she is referred for medical care, the care will be the best available.

— Dr Robert Fingerote, Toronto, ON