We all know that choosing the wrong surgeon could put our health in danger—but why would the date you have a surgery matter?
We know that spending time with young grandchildren can put you at risk for respiratory diseases—but why would it matter what time of year those grandkids were born?
As it turns out, sometimes seemingly inconsequential details can have significant effects on our health, says Harvard Medical School economist, doctor and professor Anupam B. Jena, MD, PhD. Here are five surprises to be aware of…
1. You are more likely to survive a heart attack or cardiac arrest when cardiologists leave town. Every year, thousands of cardiologists attend the conferences of the American Heart Association and the American College of Cardiology, leaving some hospital cardiology departments short-staffed. Dr. Jena, along with researchers at Harvard, University of Southern California and UC San Francisco, wondered how much damage this does to patients who experience heart problems during conference weeks. Surprising finding: It doesn’t seem to hurt these patients at all—in fact, it significantly improves their odds of survival. Patients admitted to hospitals for heart failure have a 17% mortality rate during these conferences, versus 25% at other times of year. Those experiencing cardiac arrest have a 59% mortality rate, versus 69% at other times of year. And those who have less severe heart attacks have a 13.9% mortality rate, versus 15.9% at other times of year.
Why would fewer cardiologists produce better results? Most likely explanation: When lots of cardiologists are available, they err on the side of doing too much, performing procedures where the risks outweigh the benefits. These findings were controversial but not unprecedented—numerous previous studies have found that patient mortality rates decline or at least remain level when doctors go on strike.
What to do: When a doctor recommends a medical procedure, get a second opinion if there’s time to do so. If it’s an emergency and seeking a second opinion isn’t feasible—such as with a major cardiac event—at least ask the doctor how risky the procedure is…then ask his/her degree of confidence that the procedure is justified given this level of risk. If the doctor is very confident that the procedure is the way to go, follow that guidance…but if the advice seems lukewarm, consider opting against it.
2. A grandchild with a spring or summer birthday can endanger your health. Young children born in autumn or early winter come down with flu less often than kids born at other times of year. Why is that? Young children usually get their annual checkups near their birthdays—and they often get a flu shot during those checkups. But kids born in spring and summer are less likely to get flu shots because the vaccine typically isn’t available until late August or early September—and many parents don’t bring these kids back to the pediatrician later to get this shot. Result: Only 40% of two-to-five-year-olds born in May get a flu shot, versus 55% of those born in October. This link between birth month and flu shot rates fades as children get past age six or so—older kids are less likely to get their annual checkups near their birthdays and instead more typically just before the school year starts. The vast majority of children who get the flu survive it—but the risks can be substantially greater for the grandparents who come into contact with these kids.
What to do: If your young grandkids have spring/summer birthdays, confirm with their parents that they’ve had their flu shots before any flu-season visits…and definitely get a flu shot yourself.
3. Extremely minor differences in patient age can lead to very different recommendations from doctors. One reason why retailers price products at $19.99 rather than $20 is that $19.99 feels significantly lower to our brains. This is called left digit bias—we tend to focus on the first digit in a number and largely ignore the rest. This same psychological quirk can impact our health care—a doctor who glances at a patient’s age and sees 70 or 80 might think of that patient as significantly older than someone 69 or 79, even though the actual difference between a 79-year-old and an 80-year-old might be only a few days. Example: Patients who suffer heart attacks in the two weeks before their 80th birthday are 32% more likely to undergo surgery than patients who have heart attacks in the two weeks after turning 80. These patients are essentially the same age, but doctors often decide that the aggressive approach makes more sense for the “younger” group.
What to do: If you had a birthday ending in a zero within the past year or so—or will have one within the coming year—ask your doctors if their recommendations would be any different if you were on the other side of that age line.
4. Outcomes suffer when surgical procedures are performed on surgeons’ birthdays. A study involving nearly one million surgeries performed by Dr. Jena and researchers at UCLA turned up a surprising result—the 30-day surgical mortality rate of 5.6% leaps to 7% for surgeries performed on the surgeons’ birthdays. That is a huge 25% increase in risk. Why would this be? The most likely explanation is that birthdays are sufficiently distracting to prevent surgeons from doing their best work—perhaps their minds wander to their evening plans…or they rush just a little so they don’t miss their dinner reservations.
What to do: There’s no subtle way to ask whether an operation happens to fall on the surgeon’s birthday…but there is a way to avoid scheduling an operation for a day when the doctor could be even more distracted. Ask him/her, “Will you be around during the week following my surgery in case there are any complications?” A looming vacation is likely to be an even greater distraction than a birthday. If the doctor says he/she will be taking time off the following week, ask if you could safely reschedule your procedure. It’s worth doing this even if you’re confident that your surgeon won’t be distracted by a vacation—in the event that you did have post-operative complications, you’d want your surgeon to be available rather than have to rely on someone unfamiliar.
5. Hospital inspections affect hospital care. An organization called The Joint Commission periodically conducts surprise in-depth inspections at US hospitals. Its inspectors interview staff members, confirm that protocols are being followed and evaluate hospital facilities, equipment and patient care. In the long run, these inspections ensure that hospitals function properly, but researchers wondered what effect the inspectors have in the short term—does patient care suffer during inspection weeks because the hospital staff is distracted by the inspectors…or does patient care improve because hospital staff is focused on doing its best work when they’re being watched? It turns out it’s the latter—a study by Dr. Jena and other Harvard researchers examined the results of 3,417 inspections at 1,984 hospitals and found that mortality rates decline by 0.18 percentage points during inspection weeks. They decline by an even more impressive 0.49 percentage points at major academic/teaching hospitals—those institutions tend to take Joint Commission inspections very seriously. That means more than one of every 1,000 patients who check into a hospital—and around four of every 1,000 who check into an academic/teaching hospital—are alive because they happened to be hospitalized during inspections.
The vast majority of the doctors and nurses who work in hospitals strive to provide high-quality patient care even when no one is looking over their shoulders—but it’s human nature to be a bit more attentive when someone is watching. An earlier study came to a similar conclusion—it found that intensive care unit staff washed their hands much more frequently when they knew they were being monitored.
What to do: Patients should be vigilant and involved in the care they receive. Ask polite questions and communicate your symptoms clearly. If the patient is not in a condition to do this, a loved one should do it for him/her. While a patient or family member’s oversight isn’t the same as an official Joint Commission inspection, it does let doctors and nurses know that someone is paying close attention. That can make a difference—multiple studies have found that engaged patients tend to have better health outcomes.
