Of Hospitals and Health

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I have been hospitalized numerous times for medical and surgical treatment in 10 hospitals across seven states, including the John Muir Medical Center in California mentioned in the America's Best Hospitals rankings.

In my opinion and based on my experiences, "Navigating the Hospital" [July 23-30] accurately explains to your readers what to expect when surgery is recommended. I wish this kind of information had been available prior to my surgeries and commend you for this excellent article.

Frank Crosby


Scottsdale , Ariz.  

"Navigating the hospital" mentioned that patients need to be forthcoming regarding medicines like aspirin and other blood thinners when approaching surgery. It should also be stressed that patients relay why they are taking these medicines so that they may advocate for themselves when they are asked to stop these medicines for an upcoming procedure. At the very least, the patient's physician should be contacted and asked whether these medicines could be stopped.

Beth Donnelly


Nurse Practitioner Rochester , N.Y.  

Having undergone major surgery just recently, I found "Navigating the Hospital" right on target. I found your advice for the patient to exert control and awareness to be important cautionary guidance.

Robert L. Sharp


South Pasadena , Calif.  

I truly appreciated your article concerning preparation for cardiac surgery. As a survivor of two open-heart operations, I found the information very realistic.

Rita Weldon


Wilmington , Del.  

It was great to see a portion of the recent Best Hospitals issue devoted to the work of the hospital pharmacist ["Monitoring Your Meds"]. However, references to "measuring, counting, and checking" give the general public the impression that the hospital pharmacist is just a modern version of the corner druggist. Hospital pharmacists must have access to patient medical charts regardless of whether they are a "unit pharmacist" or not. A 2002 survey by the American Society of Health-System Pharmacists showed that as many people worried about getting the wrong drug while in the hospital as those who worried about complications from the procedure. The savvy patient would be well advised soon after admission to ask to see their hospital pharmacist to ensure that the right home medications have been continued and that factors such as renal function have been taken into account for the medications started at the hospital.

Donald Zabriskie


Clinical Manager-
Pharmacy
Cleveland Clinic and Fairview/Lutheran Hospitals
Olmsted Falls , Ohio  

Your guide to America's Best Hospitals is, as usual, most informative. I was disappointed, however, that "Why Aren't Hospitals Cleaner?" did not go far enough. If you categorize and rate hospitals as thoroughly as you do, then you should add cleanliness and incidence of the bacteria methicillin-resistant Staphylococcus aureus to the ratings. Two of my close friends were determined to have contracted MRSA in the hospital. Perhaps some of the hospitals you list would not pass muster if MRSA were found in that particular hospital.

Ronald Abbey


Tavares , Fla.  

Generally speaking, I've found America's Best Hospitals interesting and essentially useful. But I'm a veteran dependent on the Veterans Administration for medical and hospital care, and these facilities and operations were not ranked. Since the VA operations encompass more than 50 major hospitals and several million patients, it seems that you are leaving a large and untenable gap in your research by ignoring them. It also raises big questions for the VA patients: Are VA hospitals suitably staffed? Do they meet appropriate standards for sanitation? Am I facing a significant risk by having major surgery at a VA hospital?

William C. Chamberlain


Hopkinsville , Ky.  

As a family physician, i am disheartened by the dearth of primary-care specialty coverage in your latest hospital rankings. Primary-care physicians continue to provide vital patient-centered medical and preventive-care services to all Americans—insured and uninsured. In today's fragmented healthcare environment, it is imperative that patients establish continuity of care to prevent and manage their acute and chronic medical problems. Physicians in primary-care specialties such as family medicine, pediatrics, and internal medicine are trained to provide this kind of "medical home" for their patients.

Jay W. Lee, M.D.


Assistant Clinical Professor
Department of Family Medicine
University of California - Irvine School of Medicine