Small-town hospitals [Southern Ohio Medical Center or SOMC epitomizes this approach] employ massive advertising to brainwash local people about the alleged great medical care available on site [very good things are happening here]. Testimonials are the mainstay of their campaign. The problem with testimonials is that they are not reliable and they lack science. A "true" testimonial is reported here, followed by few considerations.

PATIENT’S CARE AT S.O.M.C. EMERGENCY ROOM

I would now ask you to go over this case with me. I will be as critically objective as possible in giving my interpretation of facts described by the ED nurse and signed by Dr.Bruce Ashley. I will remind you that Dr.Ashley is currently working as emergency physician at SOMC. At the time of this case, Dr William Angelos was director of the ED. Dr Angelos is still the ED director.
This 50yo patient was brought to the ED unresponsive and, apparently, in respiratory arrest. I will repeat the same words in the assessment done by ED personnel:
· Unresponsive;
· Respiratory arrest x2;
· Persistent vomiting, vomiting all day, nausea and vomit;
· Abdominal pain;
· Seizures (new onset?);
· Magnesium and potassium deficiency (i.e. severe dehydration?)

Apparently, the patient was so sick that the ED doctor attempted to intubate him for at least sixteen minutes.
While the physician was trying to intubate the patient, the attending nurse documented that the patient was awake, talking, and with a saturation of 100% while breathing at 18 breaths/minute (all normal vital signs).
When the physician finally decided that he was unable to intubate the patient, he ordered the scan of the head (appropriate), and also a scan of the neck to find out soft tissue injuries possibly caused by his clumsy attempt to intubate.
No scan or other test was ordered for the abdomen (considering unresponsiveness, abdominal pain, dehydration, nausea+vomiting - it would have been reasonable to suspect an abdominal catastrophe such as leaking abdominal aneurysm or such as peritonitis/perforation).
You can verify that the patient was admitted at 23:15 and discharged less than four hours later at 03:12. In my opinion any single assessment listed above was enough to warrant an admission, or at least 24hr observation.
Instead, a patient who arrived to the ED unresponsive, after failed intubation, after a limited investigation, is discharged home less than four hours later. A legitimate question is: SOMC emergency physicians are so exceptional that they can clear an unresponsive seriously ill patient in less than 4 hours, or this is a serious case of harmful medical incompetence.
What happened after the discharge will answer this question.
Between 24 and 48 hours later (records are no longer in my hands), the same patient was brought again to the ED, this time with acute abdomen and sepsis. I was consulted as the surgeon on call. Exploratory laparotomy revealed abdominal abscess and peritonitis from a previously ruptured appendix.
It is difficult to judge medical care. It is unfair to call for medical mistakes every time that a patient does not do well. I am a physician and I know that the decision-making is usually more difficult than what appears in the aftermath of the event. Other times –and I believe this is one of these- the “mistake” is not a simple “mistake”, but a failure to apply rational and appropriate attention. This is a failure that goes beyond the single event, and has no justification. It is a failure that makes one wonder about the whole structure. “Can I trust an ED, or an hospital, where a patient arrives sick and unresponsive, and is discharged four hours later?” - this is what I would ask myself. Marketing and advertising cannot compensate for serious structural failure.
I believe that the inappropriate discharge seriously jeopardized the patient’s life. He could have died of sepsis, could have arrested again and have died before reaching the hospital. The delay made surgery and postop course more complex. I am reasonably convinced that the delay had negative influence on the physical and psychological well being of the patient for long time.


The problem with testimonials -as used in SOMC ads and by most marketers- is that they are not reliable and lack "science". In every hospital (and probably in any "business"), you can find satisfied and unsatisfied customers. Although hospitals should not be considered businesses: I believe in social universal medicine, not in a privately owned health system (we could discuss related problems in a different blog), in which the “cow-patient” is milked first, then treated accordingly.

Cancer treatment is pretty much standard, for example. The question is: how does the hospital compare with other hospitals, analyzing data based on a large court of patients? One can find outliers for the testimonial: an early stage cancer who survived very long, for example, cured in other words, can tell what a great job was done at SOMC... obviously this approach is objectively not relevant.

Testimonials are easy marketing tools; they are neither quality care parameters nor scientific data. Hospitals like SOMC are not keen to release true data, such as mortality and complication rates of -for example- acute MI in ER; discharge-readmission from ER; survival for staged breast, lung or colon cancer; type of procedures and complications weighted per severity scores; and so on. So one could really judge the true quality of delivered care.