We all know that San Luis Obispo is the happiest place in the country. But its distinctions do not end there.
Here is another local first, dug out by a respected group back East that studies surgical rates and other matters: San Luis Obispo County is first in the nation in the number of men sent for prostate surgery.
The medical term is prostatectomy, which for some reason makes me wince. But whatever you call it, our guys on the local coast are beating a path to the surgical ward to have it done.
The group that measures this is called the Dartmouth Atlas Project. It has been studying the way medicine is practiced for decades and has documented what it calls “glaring variations in how medical resources are distributed and used in the United States.”
The study was conducted under the aegis of the Dartmouth Institute for Health Policy and Clinical Practice.
Dartmouth has been crunching Medicare data for the prostate study, and it has found that men in San Luis Obispo County get a hospital referral for prostate removal at a rate of 3.8 per 1,000 compared to a national average of 1.4 per thousand.
That gives the local region “the highest rate of radical prostatectomy in the country, compared to the other 305 hospital referral regions in the U.S.” according to Eva Fowler of the Dartmouth Atlas. The group studied men older than 65 enrolled in traditional Medicare during 2003-07.
The second highest hospital referral region for prostate surgery is Lansing, Mich., with a rate of 3.2 per 1,000.
We lost out to Casper, Wyo., on back surgery and Lincoln, Neb., on knee surgery. Rates for all sorts of surgery vary all over the country, and that is exactly the point the Dartmouth Atlas is trying to make.
Lack of communication
Why is this happening?
The San Luis Obispo County Medical Association did not respond to my requests for comment.
But the researchers, who concede that they have not interviewed local doctors, say their accumulated research over the decades leads them to conclude that patients and their doctors may not be communicating as well as they might.
“Do we know for sure that the men in San Luis Obispo were not fully informed? And were not demanding prostatectomies? No, that’s a pretty tall order and a very specialized study,” Shannon Brownlee, one of the study’s authors, wrote in an e-mail.
“But it’s a reasonable inference from what we know that many were not fully informed, and that many were going on what their doctor recommended,” she wrote.
“We know from several studies that patients delegate decisions to their doctors, and their doctors don’t ask their patients about what they want,” she added, citing the studies.
“It’s been known for 30 years that doctors have different ideas” about treatment, according to Brownlee.
That would account for some doctors taking a wait-and-see attitude on prostate surgeries, while others send men to the hospital to get the organ removed.
Having a prostate removed is not a small decision. It can lead to impotence and incontinence, or both. And there are several options available short of removal, Brownlee said.
The more men really understand what the trade-offs are, the less likely they are to opt for surgery, she said.
But that kind of communication may not be taking place, researchers believe.
Failure of dialogue
Although it did not interview local doctors, the study group says it has been seeing and documenting inadequate doctor-patient dialogue across the nation for decades, going back to studies of tonsillectomies in the 1970s.
Multiple studies “have shown that patients are remarkably poorly informed,” according to Brownlee.
Ironically, she says, most doctors believe they have informed their patients about options and risks.
Brownlee said physicians are not well trained in “know(ing) how to explain things to a patient in terms the patient can understand.”
Patients, conversely, get lost in the jargon and high-toned words and end up trusting their doctors.
Dartmouth also believes that communities of doctors tend to share the same medical opinions, which would account for clusters of similar behavior in a region while there is variety across the country.
“Even when the risks and benefits of a treatment are well-documented, physicians have their own beliefs about what matters most and often value the possible treatment options differently than would their patients,” the study concludes.
“These differences in clinicians’ personal beliefs and opinions lead to differences in the kinds of treatment patients receive in different geographic locations,” according to the study.
And while doctors may differ in their ideas about treatment, there is a sort of group-think among doctors in the medical subculture of a particular geographical area.
Whether doctors hereabouts would dispute these figures, the numbers certainly provide food for thought to men who are facing prostate problems and their families.
Brownlee’s advice is to keep asking questions and conduct independent research online.
In these days of every man and woman for him- or herself vìs-a-vìs health care, that is sound advice.