Pills and Pill Bottle

Trusting Hospital Web Sites

When you are feeling ill, do you turn to the web to research your symptoms? This is a growing pastime for millions of people around the world. It is also the bane of doctors who find themselves faced with patients that have already diagnosed their conditions, decided on a treatment, and demand a particular medication or procedure.

But the truth is that we have very good reasons to research our symptoms in advance. The process for getting diagnosed by a professional has become incredibly difficult, time consuming, and expensive.

First, you make an appointment with your primary care physician – often two or three weeks away. Then after a brief lookover, she refers you to a specialist. Even when it is a mild condition, the PCP doesn’t have time to examine you in any depth and the litigation risk makes her hesitant to make any conclusive diagnosis. But of course, you have now lost half a day driving, waiting, and finding your way back to your life.

Then you repeat this process all over again with the specialist. Then a third time to schedule the procedure. Each time, you are paying a copay and towards your deductible. The portions covered by insurance still add to the overall cost of health care, increasing your premiums and the cost to the self-insured.

But where do you go for reliable information to shortcut this mess? It turns out that many of us go to hospital web sites. This makes sense. If you go through your favorite search engine, you are likely to get referred to some pretty sketchy sources. But a reputable hospital? That is a source I can believe in.

Maybe not so much.

A recent study in the supremely reputable Journal of the American Medical Association reviewed the web sites of 262 U.S. hospitals. They focused on a relatively new procedure called transcatheter aortic valve replacement. Because it is new, hospitals have a pretty good profit margin on the procedure – billing your insurance company a pretty penny. This gives them a strong profit incentive to overprescribe the procedure. Not that they would prescribe it to a patient that clearly doesn’t need it. But if someone is in that gray area between a cheap generic drug and a highly profitable procedure . . . . . . .

Transcatheter aortic valve replacement (TAVR) has been recently approved by the US Food and Drug Administration for the treatment of severe aortic stenosis among carefully selected patients; recent randomized clinical trials have identified important positive and negative outcomes of TAVR in these populations, including twice the risk of stroke for patients undergoing TAVR vs those undergoing open aortic valve replacement.

You might think I am being cynical, but the evidence backs me up. This study found that 99% of the hospital web sites describe the benefits of the procedure compared to the alternatives, but only 26% mention any of the risks. This is despite the fact that one risk of this procedure is stroke – something I would want to know about in advance.

The medical ethicists involved in the study characterize the hospital descriptions as advertising rather than impartial educational resources. But how many of us think this way when we are doing our self-diagnosis? If I am on a drug company’s web site, I might be skeptical of what I read. But a hospital? I thought I could trust that to be impartial. I guess not.

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