Comparing Hospitals

We are a society that loves comparing ourselves to our peers. Hospitals do not escape such scrutiny. Each year, the U.S. News World Report ranks hospitals, and hospitals love boasting about their rankings. It's good press, good for morale, and an affirmation of the work we do. But such ranking lists need to be taken with a boulder of salt. The task of comparing hospitals on performance in area as big as "cardiovascular medicine," "cancer," or "rehabilitation" is herculean if not impossible. There are too many factors in play. To imagine one can look at rates of complications, reputation, ability to perform high risk procedures, adherence to guidelines, cutting edge technology, and a dozen other factors and come up with a score is folly. Would you rather go to a hospital that follows national guidelines or to one that is cavalier and breaks rules yet achieves better outcomes? Would you rather go to a hospital that realistically says a surgery is too high risk or to a hospital willing to take that risk and operate? The presence of a few experts does not automatically elevate their department's quality of care. The reputation of an institution may have little bearing on how their patients do. Yet the U.S. News World Report tries to plug all these things into a magical formula to come out with a list. No doubt the institutions on the list are outstanding, but to think there is rhyme or reason to where they fall in the ranking is silly. The art and science of medicine cannot be quantified. We all strive to provide the best care, right care, humanistic care, and we should heed little to our society's love of comparing things.