All very fair and well points.

Dr. Todd Zimmerman 

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-----Original Message-----
From: Doc Holiday <[log in to unmask]>
To: PED-EM-L <[log in to unmask]>
Sent: Mon, Apr 8, 2013 3:09 pm
Subject: Re: Our Future

From: [log in to unmask]> Throughout my career I have worked in Florida and 
-> I have spent many vacation weeks in Florida. I am writing from Florida right 
ow, actually (flying back to the UK tomorrow to see some snow). I also spent a 
ouple of years being "in Florida" each week as a cruise doctor.
ever been to IL yet. It's a plan...
 I likely have seen about 5-10 Canadian patients per year, a few from Dubai, a 
ew from the Netherlands, a few from other parts in the world.
-> Where I currently work in the UK, I don't get this, but I did when I worked 
n Central London for a number of years, at some of the more famous 
 This is in no way scientific obviously by any means
-> You're very right. This was one of my points. We should stop setting 
urselves images/standards/targets/goals which drive expectations beyond what 
ur MEDICAL mind tells us...
 ...every foreign patient notes there healthcare in there country is no where 
ear as good as the healthcare we provide
-> First, then, you must be congratulated on working at a place which gets such 
ompliments. As we all know, complaints do happen in ED (I don't just mean ones 
hich are aimed at litigation) so it's really pleasing to receive good feedback.
 can tell you that, from recall, when I worked, for example, at St. Thomas 
ospital in London, directly across the Thames from the Houses of Parliament, I 
aw many Americans, Canadians and other-ians. Even there, I could not say 100% 
f my foreigners gave such praise, although we were close to 100%. Still, this 
as many years ago, before surveys and the like...
hen I went to Dubai only recently and visited one of the facilities there, 
ehre a friend of mine works, I saw an ED which compares perfectly well with ANY 
rit/American one. It has all the modern stuff and it also has physicians from 
he USA, CA, UK and local, so this is not surprising. Maybe the Dubai patient 
ou saw goes to another ED in Dubai or else they might have said they DID have 
omething as good...
 think the point which many have hinted at is that not all patients get to go 
o places like yours, or this one in Dubai or some of the more impressive London 
 These are typically well to do patients as well...
-> This brings us nicely to the crux and I would like you to accept that the 
oints I make below do not arise from disputing any of the good feedback you 
ave described above, which I am certain was well-earned by your ED.
ealthcare system quality is NOT well-represented by the EM care received by a 
here's much more in the pie chart from primary care, rural areas, 
ingle-income-young-couples-at-minimum-wage, multi-pathology-chronic-patients-with-under-insurance, 
tc... It's THESE people who drag the average down for the USA, despite there 
eing some really shiny stars in it, like your ED.
nd another thing which further downgrades the quality of the statistics is when 
e use the opinion of patients about quality. They are really insufficiently 
rained in assessing quality and often focus on the wrong attributes, e.g. 
ating a "nice" doctor above a good one, a short wait above an effective 
irst-time diagnosis, a well-decorated high spec venue above one with better 
urgical outcomes or, as more and more we hear these days, they LOVE places with 
ood visiting hours although these may come at the risk of more infection 
pread. A nice carpet and lick of paint may well put one place above another, 
espite the latter being actually better when professionally assessed. 		 	   		  
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