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Transplantation Darts and Laurels

Posted Oct 21 2008 12:51am
The Columbia Journalism Review has a section called " Darts and Laurels", in which the editors offer short commentary on recent events in journalism, either negative or positive. With full credit and due respect to the CJR, I want to borrow their nomenclature and apply it to two recent items in the field of liver transplantation here in New England.

I understand fully that offering this kind of commentary about other hospitals is dangerous business, violating unspoken protocols in the health care field. But if we can't be open and forthright on matters relating to cost and quality, how can we expect the public to trust us? In the interest of full disclosure, I freely admit that my comments also can be viewed as an attempt to enhance BIDMC's competitive position in the region. But that does not necessarily mean that they do not have validity. You be the judge. The power of a blog like this is that anyone can offer comments in rebuttal -- or even set up their own blog.

First, a "laurel" to Dartmouth-Hitchcock Medical Center in Hanover, NH, for reportedly cancelling their plans to establish a liver transplantation program. As discussed on this blog on October 13, 2006, and as supported by commentors at that time, it is difficult to rationalize the establishment of this highly technical and expensive program for the very few patients who would be treated. We recently received word that these plans had been scuttled. If so, congratulations.

Next, a small "dart" to UMass Memorial Medial Center and Lahey Clinic for something that could otherwise be a big "laurel". In December, the two institutions announced a joint program in liver transplantation. This is a fine idea and shows the power of collaboration between two great places. But here's where we award a "dart":

UMass Memorial and Lahey Clinic will continue to function as independent transplant centers, caring for their own patients from intake to surgery, through continuing care. Surgeons and medical staff will have access to and privileges at each center and will perform operations, consult with patients, and provide post-operative care at both sites.

For the volume of liver transplants to be done in Worcester, and the relative number of faculty based at the two places, it probably makes more sense to move those patients to Lahey for surgery. Otherwise, Lahey doctors will have to travel an hour to go 50 miles to Worcester to perform surgeries and otherwise be on-call for patients there. This seems to be one of those examples where a slightly less convenient approach for those few patients would help maintain a greater critical mass for a program in one setting.

I hope to be proven wrong on this point, but I cannot imagine how asking Lahey doctors to commute to Worcester for a relatively small liver transplantation program will be a good use of their time or will optimize patient care and control costs overall.
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