The Best Hospitals
An exclusive survey of more than 1,000 leading doctors yields 43 sources of top medical care
Despite dozens of private and government attempts to measure quality of care, a hospital's reputation with physicians is still the most reliable barometer. Doctors know where their patients tend to do best, and conferences and journals keep them informed on sources of the very latest care. The third annual U.S. News reputational survey of leading physicians turned up 43 top-quality hospitals in 16 specialties. The exclusive survey was conducted by the National Opinion Research Center, a renowned social-science research group at the University of Chicago. This year's hospitals survey includes one new specialty: At the behest of many readers, doctors and hospitals, hospital-based geriatrics programs were added to the list.
To select the specialists polled, NORC drew 146,125 names of board-certified physicians across the 16 specialties. The names were randomly chosen from the American Medical Association's master file of more than 560,000 AMA members and nonmembers. NORC then selected a geographically representative sample of 100 doctors per specialty, for a total of 1,600 physicians. NORC contacted them by mail and followed up as necessary by fax, express mail and phone between January and April 1992. NORC's persistence produced a remarkably high response rate of 65 percent for the confidential survey.
Each physician was asked to name the five leading hospitals in his or her specialty, regardless of location or expense and in no special order. The doctors named 389 hospitals, many in more than one specialty, out of some 6,700 U.S. institutions. For a hospital to be listed, the number of "best" citations had to be well above the mean (in statistical terms, one standard deviation above the mean) in its specialty. That produced lists of varying lengths. The percentage of doctors who named each hospital is included in the lists on the following pages.
Any institution that made a list should be considered a leading center, no matter where it appears. And the survey does not imply that other hospitals cannot or do not deliver excellent care; these are simply the hospitals about which there is the strongest consensus among U.S. physicians. There are 18 new entries among the various specialties, and 19 hospitals on last year's lists are absent this time around. But different doctors were surveyed in each of the two years, which can subtly shift the statistical cutoff that determines whether a hospital makes the list.
In order to make the rankings more objective, this year's survey also asked doctors to indicate the relative importance of various attributes of good care. These ranged from the quality of the medical staff and the availability of state-of-the-art technology to competent discharge planning and the degree of emotional support for patients and their families.
The answers provided NORC with a variety of promising indicators, all of which can be expressed objectively. Among them are the ratios of registered nurses and of interns and residents to patient beds and membership in the Council on Teaching Hospitals, which requires that applicants meet high educational and research standards. As a first step toward building in an objective approach, that information is provided for each hospital listed in the directory starting on Page 89. Those and other emerging signposts to hospital quality care will be incorporated into future surveys.
AIDS SAN FRANCISCO GENERAL HOSPITAL / 61 pct.
MASSACHUSETTS GENERAL HOSPITAL BOSTON / 27 pct.
JOHNS HOPKINS HOSPITAL BALTIMORE / 22 pct.
UCLA MEDICAL CENTER LOS ANGELES / 18 pct.
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO MEDICAL CENTER / 16 pct.
MEMORIAL SLOAN-KETTERING CANCER CENTER NEW YORK / 14 pct.
CLINICAL CENTER, NATIONAL INSTITUTES OF HEALTH BETHESDA, MD. / 12 pct.
HIV infection opens the door to dozens of "opportunistic" diseases; AIDS specialists have to be familiar with the many therapeutic drugs used to fight them. As more is learned about treating HIV-related diseases, hospitals are moving toward outpatient care. Most patients prefer staying at home, where they are also less exposed to hospital-based infections.
EXPERT'S VIEW
PAUL VOLBERDING, professor of medicine at the University of California, San Francisco and director of the AIDS program at San Francisco General Hospital: You need to be willing to take care of the patient, and you need to know a lot about the disease. HIV infection is complex, but there are clear patterns. That makes experience crucial--if I were a patient I'd want the hospital to have seen several hundred cases. Experience helps you decide whether to treat the patient as an inpatient or an outpatient. A drop over time in the incidence of pneumocystis pneumonia means the hospital is giving high-quality preventive care. In this disease it's especially important to be doing clinical trials. That way you know what's happening before it's published. When things change as rapidly as they have in HIV disease, it gives the doctor and the hospital an edge they might otherwise not have.
RESOURCES
Project Inform, (800) 822-7422 outside California, (800) 334-7422 in California. Drug and treatment information. National Institute of Allergy and Infectious Diseases, (800) 874-2572. Trials of new drugs. National Association of People with AIDS, (202) 898-0414, or on-line bulletin board, (703) 998-3144. Current news, support-group listings.
CANCER UNIVERSITY OF TEXAS (M.D. ANDERSON CANCER CENTER) HOUSTON / 62 pct.
MEMORIAL SLOAN-KETTERING CANCER CENTER NEW YORK / 57 pct.
DANA-FARBER CANCER INSTITUTE BOSTON / 36 pct.
MAYO CLINIC ROCHESTER, MINN. / 23 pct.
STANFORD UNIVERSITY HOSPITAL STANFORD, CALIF. / 22 pct.
Cancer care has become extremely complex, and tumors are being diagnosed earlier; but surgery, chemotherapy and radiation still define the treatment options. Most large hospitals employ all three. Because cancer is really many different diseases, even large hospitals often have true expertise in diagnosing and treating only a few types of cancer.
EXPERT'S VIEW
JAMES COX, physician-in-chief, University of Texas, M.D. Anderson Cancer Center: A good cancer hospital will have a solid multidisciplinary approach where a single method of treatment, like radiation, doesn't dominate. I would go to a different hospital if the surgeons, radiation and chemotherapy experts couldn't agree on the best approach to treating my cancer. Another hallmark of top-quality care is that the hospital routinely sends out its lab work, such as tissue biopsies, for outside review. Any lab can make a mistake. I'd also find out if there is an emphasis on treatments that spare organs. Increasingly, that is possible with cancers of the breast, prostate, bladder and larynx, for example. Finally, I would check to see if the hospital has a full complement of imaging equipment such as MRIs and CAT scanners. Those are becoming more and more critical to an accurate diagnosis.
RESOURCES
National Cancer Institute, (800) 422-6237. Provides lists of major cancer treatment centers and helps locate clinical trials. American Cancer Society, (800) 227-2345. Provides basic information on various kinds of cancer. Refers to local ACS offices and support groups. Offers access to databases that assess treatment success rates.
CARDIOLOGY MAYO CLINIC ROCHESTER, MINN. / 38 pct.
CLEVELAND CLINIC / 36 pct.
TEXAS HEART INSTITUTE (ST. LUKE'S EPISCOPAL HOSPITAL) HOUSTON / 21 pct.
STANFORD UNIVERSITY HOSPITAL STANFORD, CALIF. / 20 pct.
MASSACHUSETTS GENERAL HOSPITAL BOSTON / 19 pct.
EMORY UNIVERSITY HOSPITAL ATLANTA / 16 pct.
JOHNS HOPKINS HOSPITAL BALTIMORE / 14 pct.
All cardiology departments treat a wide range of heart and circulatory problems, from angina pectoris, or chest pain, to clogged coronary arteries. But cardiologists in larger medical centers have special expertise in treating unusual or especially complicated cases--for example, those involving congenital heart disease, valve problems and serious rhythm disorders.
EXPERT'S VIEW
HUGH SMITH, chief of cardiology, Mayo Clinic: There has to be an underlying philosophy and commitment that patient care comes first. We have rejected appointments to absolutely brilliant doctors because they are either arrogant or do not provide what I would call empathetic care. We also use a holistic approach in which one primary care giver directs the patient's team of specialists. That sets up a group dynamic that makes people strive to be as good as or perhaps better than their fellow team members. You can call it a form of peer pressure. We are also geared up at Mayo to do long-term analysis on patient-benefit outcome, cost-effectiveness of treatments and continuous quality management. That lets us identify the best therapy or a treatment that was unnecessarily costly. And we are salaried. This takes the marketplace out of how we treat the patient and permits us to do our very best.
RESOURCES
American Heart Association. Local offices provide information and referrals. National Heart, Lung and Blood Institute, (301) 496-4236. Informational pamphlets from the federal government. Self-help. Mended Hearts, (214) 706-1442, membership $15 individual; $22 family. Coronary Club, (216) 444-3690, newsletter $20 a year.
ENDOCRINOLOGY MAYO CLINIC ROCHESTER, MINN. / 63 pct.
MASSACHUSETTS GENERAL HOSPITAL BOSTON / 62 pct.
CLINICAL CENTER, NATIONAL INSTITUTES OF HEALTH BETHESDA, MD. / 32 pct.
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO MEDICAL CENTER / 26 pct.
JOHNS HOPKINS HOSPITAL BALTIMORE / 24 pct.
BARNES HOSPITAL ST. LOUIS / 20 pct.
Endocrinologists treat diseases marked by over- or underproduction of the hormones that regulate such functions as growth, digestion and reproduction. Commonplace disorders include diabetes, osteoporosis and menstrual irregularities; rare conditions include hormone-producing tumors. The specialty relies on blood tests and extensive knowledge of the endocrine glands.
EXPERT'S VIEW
HENRY KRONENBERG, head of the endocrinology unit at Massachusetts General Hospital: A top-notch endocrine division is busy, since seeing a lot of patients is an important part of keeping up. Except for those times when surgery is needed, we see most of our patients as outpatients. When patients come from all over, it tells you that the center has experience with rare conditions and has a good reputation with referring doctors. An active training program for young doctors tells you that the faculty has been approved as teachers by the American Board of Internal Medicine. In endocrinology, there are almost no procedures. Much more crucial than the ability to do a tricky procedure is the knowledge of what sort of tests ought to be done and what treatment is called for. And when surgery is needed, only big academic or clinical centers offer access to surgeons who specialize in endocrine surgery.
RESOURCES
American Diabetes Association (see the white pages). Pamphlets, fact sheets, answers to individual questions. American Thyroid Association, (800) 542-6687. Pamphlets and referrals to board-certified endocrinologists. National Osteoporosis Foundation, (800) 223-9994. Free 22-page booklet on osteoporosis.
GASTROENTEROLOGY MAYO CLINIC ROCHESTER, MINN. / 42 pct.
MASSACHUSETTS GENERAL HOSPITAL BOSTON / 35 pct.
CLEVELAND CLINIC / 31 pct.
JOHNS HOPKINS HOSPITAL BALTIMORE / 24 pct.
UCLA MEDICAL CENTER LOS ANGELES / 20 pct.
MOUNT SINAI MEDICAL CENTER NEW YORK / 20 pct.
Gastroenterology departments treat digestive disorders from routine heartburn and abdominal pain to ulcers, liver disease and cancer. Endoscopic ultrasound--organ scans from inside the body using sound waves--has boosted cancer screening effectiveness, and new drugs that suppress the immune system have turned liver transplants into reliable lifesavers.
EXPERT'S VIEW
MICHAEL SIVAK, chairman, department of gastroenterology, Cleveland Clinic: Gastroenterology has become so complex that it is subspecialized, and any really good department is involved in training these subspecialists. We have gastroenterologists training in endoscopy and liver disease, for example. There are many good hospitals without training programs, but I think training reveals a certain dedication. Some people are put off by an attending physician who is in training. But the trainee is already certified in internal medicine. The level of skill of the trainees coming through now is so high that there's no way they can get away without knowing what they're doing. The best institutions also do research and publish the results. That reveals two things: the hospital's particular area of interest and physicians who are constantly questioning, looking for better treatment. Also, gastroenterology is more and more technology oriented, and ongoing research reveals a dedication to stay at the forefront of technology.
RESOURCES
National Digestive Diseases Information Clearinghouse, Box NDDIC/USN, 9000 Rockville Pike, Bethesda, MD 20892. American Liver Foundation. Patient information and referrals, (800) 223-0179. "Gut Reactions," by W. Grant Thompson, M.D. ($22.95, 1989, Plenum Press). A lay-language discussion of digestive disorders.
GERIATRICS UCLA MEDICAL CENTER LOS ANGELES / 22 pct.
BETH ISRAEL HOSPITAL BOSTON / 21 pct.
DUKE UNIVERSITY MEDICAL CENTER DURHAM, N.C. / 18 pct.
MOUNT SINAI MEDICAL CENTER NEW YORK / 16 pct.
MASSACHUSETTS GENERAL HOSPITAL BOSTON / 14 pct.
JOHNS HOPKINS HOSPITAL BALTIMORE / 10 pct.
Geriatrics departments or programs are staffed by internists trained to diagnose and treat the many diseases and disorders of old age. Typical patients are in their 80s and are being treated for four or more conditions, including such problems as heart disease, arthritis, Alzheimer's or disabilities due to stroke. Geriatric programs also provide social and psychological services.
EXPERT'S VIEW
ROBERT BUTLER, chief of geriatrics, Mount Sinai Medical Center: Older patients who are being treated for, say, heart disease, diabetes and arthritis and worry that their care is not really integrated should look for geriatrics programs that offer comprehensive assessments, which can be done on an outpatient basis. Often we spot undiagnosed underlying conditions. That's because disease affects older people differently than it does other patients. An overactive thyroid may not cause the usual metabolic symptoms; a heart attack may cause confusion, not chest pain. Because we have the expertise to provide the primary care for all of our patients' medical problems, there is better coordination of care. In prescribing medications, for instance, we guard against drug interactions. And we can help patients overcome social and psychological problems as well by bringing them together with home-health aides, social workers and psychologists. We also help patients understand what we're doing when technical procedures are involved.
RESOURCES
National Council on the Aging. (202) 479-1200. Pamphlets on elder care and nutrition. The National Institute on Aging, (800) 222-2225 for free information; (800) 438-4380 to talk with information specialists about Alzheimer's. American Association of Retired Persons, (202) 434-2277. Information on medical and social issues; membership $5 a year ($8 Sept. 1).
GYNECOLOGY BRIGHAM AND WOMEN'S HOSPITAL BOSTON / 14 pct.
JOHNS HOPKINS HOSPITAL BALTIMORE / 14 pct.
MAYO CLINIC ROCHESTER, MINN. / 13 pct.
UNIVERSITY OF TEXAS (M.D. ANDERSON CANCER CENTER) HOUSTON / 11 pct.
DUKE UNIVERSITY MEDICAL CENTER DURHAM, N.C. / 9 pct.
MASSACHUSETTS GENERAL HOSPITAL BOSTON / 8 pct.
YALE-NEW HAVEN HOSPITAL / 7 pct.
MEMORIAL SLOAN-KETTERING CANCER CENTER NEW YORK / 6 pct.
Gynecology deals with problems of the female reproductive tract, and most hospital departments include obstetrics as well. A good department can tap the talent of experts in genetics, infectious diseases, surgery, endocrinology and cancer to treat diseases like endometriosis, ectopic pregnancy, uterine bleeding and fibroid tumors.
EXPERT'S VIEW
CHARLES HAMMOND, chairman, obstetrics and gynecology department, Duke University: When you have a confusing diagnosis or a rare condition or you're not responding to treatment, it may be time to check out a medical center with a strong reputation. A community obstetrician/gynecologist may see one placental tumor in a lifetime, but a referral center may have half a dozen cases at any one time. The presence of subspecialists in reproductive endocrinology and infertility, maternal and fetal medicine and gynecologic oncology suggests the faculty is top-notch and can handle complex problems. For cancer, I'd want to know if the hospital tests new drugs and approaches and has a gynecological oncologist on staff. And for in vitro fertilization, I'd like to see a success rate of better than 15 percent per cycle--for a take-home baby, not a pregnancy.
RESOURCES
American Fertility Society, (205) 933-8494. Booklets on reproductive health and fertility. American College of Obstetricians and Gynecologists. Pamphlet list; send an SASE to ACOG, 409 12th Street, S.W., Washington, DC 20024. National Women's Health Network, (202) 347-1140. A $5 donation brings packets on health issues of concern to women.
NEUROLOGY MAYO CLINIC ROCHESTER, MINN. / 60 pct.
MASSACHUSETTS GENERAL HOSPITAL BOSTON / 49 pct.
JOHNS HOPKINS HOSPITAL BALTIMORE / 39 pct.
CLEVELAND CLINIC / 36 pct.
COLUMBIA-PRESBYTERIAN MEDICAL CENTER NEW YORK / 31 pct.
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO MEDICAL CENTER / 28 pct.
UCLA MEDICAL CENTER LOS ANGELES / 19 pct.
Doctors in neurology departments treat widely ranging muscle and central-nervous-system problems from parkinsonism and multiple sclerosis to Alzheimer's, epilepsy, stroke and spinal-cord injuries. At most major hospitals, rehabilitation and psychiatry play an increasingly important role in neurology departments.
EXPERT'S VIEW
LEWIS ROWLAND, chief of neurology, Columbia-Presbyterian Medical Center: We've run counter to the modern demands for more general physicians by allowing specialists in neurology to become superspecialists in particular groups of diseases, such as movement disorders, neuromuscular diseases and problems involving dementia. The amount of knowledge available is so huge that people have to focus if they're going to be on the front lines. Superspecialists are best able to make an early diagnosis for Parkinson's, epilepsy, Lou Gehrig's disease, multiple sclerosis, stroke and dementia--disorders best managed early on. They're aided by neuroradiologists, neuropathologists and neuroepidemiologists, who try to decipher whether these diseases strike certain people differently. And because neurology departments with dedicated centers for diseases like these are on the forefront, they can offer treatment trials and comprehensive care, such as rehabilitation and social services.
RESOURCES
National Institute of Neurological Disorders and Stroke, (301) 496-5751. Information from the federal government. Self-help. Parkinson Support Groups of America, (301) 937-1545. ALS Association, (818) 340-7500. Spinal Cord Society, (218) 739-5252. The National Multiple Sclerosis Society, (800) 624-8236. Alzheimer's Association, (312) 335-8700.
OPHTHALMOLOGY JOHNS HOPKINS HOSPITAL (WILMER EYE INSTITUTE) BALTIMORE / 64 pct.
BASCOM PALMER EYE INSTITUTE (UNIVERSITY OF MIAMI) / 55 pct.
WILLS EYE HOSPITAL PHILADELPHIA / 42 pct.
MASSACHUSETTS EYE AND EAR INFIRMARY BOSTON / 35 pct.
UCLA MEDICAL CENTER (JULES STEIN EYE INSTITUTE) LOS ANGELES / 28 pct.
UNIVERSITY OF IOWA HOSPITALS AND CLINIC IOWA CITY / 18 pct.
Ophthalmologists diagnose and treat disorders of the eye. Virtually all large hospitals have ophthalmology departments, but not all have a full complement of subspecialists. Separate eye institutes or clinics within or attached to larger hospitals are now common and generally indicate a higher order of expertise.
EXPERT'S VIEW
JOHN CLARKSON, chairman, Department of Ophthalmology, the Bascom Palmer Eye Institute at the University of Miami, Fla.: Ophthalmologists in a given geographical area usually know each other's areas of subspecialization. You want to find the doctor who handles your problem day in and day out and knows it cold. I also think the bigger departments are better, since they are more likely to have the most sophisticated technology, such as ophthalmic ultrasound machines to detect ocular tumors or the latest laser-beam equipment. Opthalmology is very much a technology-driven specialty. The people who work with this equipment all the time are the ones who are going to be able to give you the best care. For truly special needs, a person needs to get to the major hospitals or specialty eye clinics, where the support staff is trained to deal with patients with eye problems. That might include social support for those who have lost or are going to lose their sight.
RESOURCES
National Eye Institute, Box 2020, Bethesda, MD 20892. Basic information, lists of clinical trials. American Academy of Ophthalmology, 665 Beach Street, San Francisco, CA 94120. Basic information, lists of treatment centers. American Foundation for the Blind, (202) 457-1487. Information on programs for the visually impaired and blind.
ORTHOPEDICS HOSPITAL FOR SPECIAL SURGERY NEW YORK / 41 pct.
MASSACHUSETTS GENERAL HOSPITAL BOSTON / 35 pct.
MAYO CLINIC ROCHESTER, MINN. / 29 pct.
DUKE UNIVERSITY MEDICAL CENTER DURHAM, N.C. / 22 pct.
JOHNS HOPKINS HOSPITAL BALTIMORE / 19 pct.
CLEVELAND CLINIC / 16 pct.
Orthopedists perform bone and joint operations, such as total joint replacements, to correct conditions often caused by arthritis or osteoporosis. They also repair sports-related injuries to muscles. Sophisticated new techniques using screws and plates instead of a body cast have dramatically shortened recovery periods.
EXPERT'S VIEW
ANDREW WEILAND, surgeon in chief, Hospital for Special Surgery: There are a lot of questions that patients don't ask but should. They should ask about anesthesia, for example. About 90 percent of orthopedic surgery can be done under regional or local anesthesia, which is much safer than general anesthesia since the patient breathes on his own and there are fewer complications. Some patients don't even ask about rehabilitation, which is half the show. Patients should ask for details--what their rehabilitation program will be and how long it will be until they're walking without a cane or a crutch. A surgeon doing a lot of joint replacements, for example, should be able to tell patients how long it will take to get their strength back and when they'll be able to start playing golf again. It's also important to look for a sophisticated rehabilitation facility, with a large staff of certified physical therapists and all the fancy equipment. A rehabilitation facility that's not up to date can slow your progress.
RESOURCES
American Academy of Orthopaedic Surgeons. Free information with stamped, self-addressed envelope, P.O. Box 618, Park Ridge, IL 60068. Arthritis Foundation, (800) 283-7800. Provides information on treatment and exercise and refers callers to local chapters. National Osteoporosis Foundation, (800) 223-9994. Free 22-page booklet on osteoporosis.
OTOLARYNGOLOGY UNIVERSITY OF IOWA HOSPITALS AND CLINICS IOWA CITY / 30 pct.
MASSACHUSETTS EYE AND EAR INFIRMARY BOSTON / 26 pct.
JOHNS HOPKINS HOSPITAL BALTIMORE / 21 pct.
UCLA MEDICAL CENTER LOS ANGELES / 20 pct.
MAYO CLINIC ROCHESTER, MINN. / 18 pct.
UNIVERSITY OF TEXAS (M.D. ANDERSON CANCER CENTER) HOUSTON / 18 pct.
UNIVERSITY OF MICHIGAN MEDICAL CENTER ANN ARBOR / 17 pct.
Much of the work of the specialists in the "ear, nose and throat" department still deals with such common conditions as tonsillitis and sinus and ear infections. But otolaryngologists are also specialists in deafness and in cancers of the throat and larynx, and many are expert in facial plastic surgery as well.
EXPERT'S VIEW
BRIAN McCABE, chief of otolaryngology, University of Iowa: Anyone seeking care for, say, throat or sinus cancer should be sure the department not only has diagnosticians, surgeons, oncologists and high-tech radiation therapists but also speech pathologists and specialists in the construction of prostheses--artificial facial replacements. When we can't reconstruct a part of a face, we can make a prosthesis that would not be discernible as artificial from across a room. Patients should also find specialists to help restore speech. Many patients are grandparents. If they look bad or different, it can turn a grandchild off, which can be very wounding to a grandparent. So it is important to pick a center willing to involve the whole family. By dealing with appearance and function as well as the cancer and by having family members meet the doctors and nurses, we can foster acceptance.
RESOURCES American Academy of Otolaryngology, (703) 836-4444. Informational booklets on ear, nose and throat diseases. Self-help. Let's Face It, (508) 371-3186, support for people with facial disfigurement, membership $10 a year; Self-Help for Hard of Hearing People, (301) 657-2248, information and referral; membership $20 a year.
PEDIATRICS CHILDREN'S HOSPITAL BOSTON / 48 pct.
CHILDREN'S HOSPITAL OF PHILADELPHIA / 38 pct.
JOHNS HOPKINS HOSPITAL BALTIMORE / 29 pct.
CHILDRENS HOSPITAL OF LOS ANGELES / 14 pct.
RAINBOW BABIES AND CHILDRENS HOSPITAL (UNIVERSITY HOSPITALS OF CLEVELAND) / 12 pct.
For serious problems, children's hospitals tend to be superior to pediatric units in general hospitals. Their doctors and nurses are skilled in the most advanced microtechniques, and their labs can deal with small specimens. Doctor, parent and child form more of a partnership, with all of them discussing the child's case together.
EXPERT'S VIEW
DAVID CORNFELD, deputy physician-in-chief, Children's Hospital of Philadelphia: If a child is healthy and needs only routine hospital care, the convenience of a hospital has to be a major issue; you want access and availability. For sick children, however, especially those with chronic illnesses, parents should find a hospital that fully services the child's specific problem. In such cases, a children's hospital offers several advantages over a general hospital with a pediatrics unit. Since a child's chronic illness may have different causes and facets, children's hospitals are usually deep in personnel in different specialties. A children's hospital is more likely to have physicians who are certified as pediatric specialists rather than specialists who deal mostly with adults and treat children as a sideline. And children's hospitals are where parents are likelier to find support groups that address their difficulties.
RESOURCES
Federation for Children with Special Needs, (617) 482-2915. What to ask before surgery, and answers to other parental concerns. Parent Network, (301) 654-6549. Provides referrals to advocacy groups and other parents of sick children. Self-help. Most children's hospitals have information centers that are open to the public.
PSYCHIATRY McLEAN HOSPITAL BELMONT, MASS. / 22 pct.
MENNINGER CLINIC TOPEKA, KAN. / 18 pct.
UCLA MEDICAL CENTER LOS ANGELES / 15 pct.
MASSACHUSETTS GENERAL HOSPITAL BOSTON / 14 pct.
SHEPPARD AND ENOCH PRATT HOSPITAL BALTIMORE / 13 pct.
INSTITUTE OF LIVING HARTFORD, CONN. / 12 pct.
MAYO CLINIC ROCHESTER, MINN. / 11 pct.
COLUMBIA-PRESBYTERIAN MEDICAL CENTER NEW YORK / 10 pct.
NEW YORK HOSPITAL-CORNELL MEDICAL CENTER NEW YORK / 10 pct.
YALE-NEW HAVEN HOSPITAL / 9 pct.
The current fashion is to think of mental illness as a biological disorder, and therefore one that responds to drugs. Medication has its place, but mending the mind is not like mending the body. It takes a vastly more human touch, and good hospitals increasingly emphasize a proper balance between drugs and psychotherapy.
EXPERT'S VIEW
STEVEN MIRIN, psychiatrist-in-chief, McLean Hospital: The most important thing to look for is a continuum of care that extends beyond the patient's hospital stay. Are there day and evening programs for ex-patients? Or outpatient psychotherapy from the same people who treated you in the hospital? Is partial hospitalization available--nights only, for example, if that makes sense? When patients are discharged, they should get more than a phone number. They should feel that the hospital will be there for them when and if they need it. I also put a lot of stock on a team approach that brings doctors, psychologists, nurses and social workers together to both work with patients and assess their progress.
RESOURCES
National Alliance for the Mentally Ill, (800) 950-6264. Over 1,000 chapters nationwide. Information on local facilities, insurance coverage, legal help and support groups. National Association of Private Psychiatric Hospitals, (202) 393-6700. List of facilities in your area and special programs offered, such as alcohol treatment centers.
REHABILITATION
REHABILITATION INSTITUTE OF CHICAGO / 51 pct.
UNIVERSITY OF WASHINGTON MEDICAL CENTER SEATTLE / 46 pct.
MAYO CLINIC ROCHESTER, MINN. / 31 pct.
CRAIG HOSPITAL ENGLEWOOD, COLO. / 31 pct.
THE INSTITUTE FOR REHABILITATION AND RESEARCH (TIRR) HOUSTON / 26 pct.
RUSK INSTITUTE FOR REHABILITATION MEDICINE (NEW YORK UNIVERSITY MEDICAL CENTER) / 26 pct.
RANCHO LOS AMIGOS MEDICAL CENTER DOWNEY, CALIF. / 18 pct.
Rehabilitation units treat people who are disabled because of head and spinal injuries, strokes, amputations and arthritis, as well as people who have been injured in falls or sports. Patients are encouraged to leave the hospital as soon as possible and to strive for independence while undergoing outpatient rehabilitation.
EXPERT'S VIEW
HENRY BETTS, chief executive officer and medical director, Rehabilitation Institute of Chicago: Rehabilitation patients go through a lot of psychological stress. They often have had dire things happen to them, and they may have to learn to adapt to some remaining disability even after rehabilitation. Choosing a hospital with an environment that will motivate them to get through the process is particularly important. They should tour a hospital first to get a sense of whether it seems positive and dynamic, whether the staff is energetic and upbeat. The facility itself is far less important than the individuals who run it. Patients should also check that full-time attending physicians are in charge of the patients and the teams, not doctors who come in in the morning and aren't around the rest of the day.
RESOURCES
American Academy of Physical Medicine and Rehabilitation. Free list of rehabilitation specialists with a stamped, self-addressed envelope, 122 S. Michigan Ave., Suite 1300, Chicago, IL 60603. American Paralysis Association, (800) 526-3456. Spinal cord injury hot line. National Council on Independent Living, (518) 274-1979. Life after rehabilitation.
RHEUMATOLOGY MAYO CLINIC ROCHESTER, MINN. / 46 pct.
HOSPITAL FOR SPECIAL SURGERY NEW YORK / 27 pct.
BRIGHAM AND WOMEN'S HOSPITAL BOSTON / 26 pct.
UCLA MEDICAL CENTER LOS ANGELES / 24 pct.
JOHNS HOPKINS HOSPITAL BALTIMORE / 16 pct.
UNIVERSITY OF ALABAMA HOSPITAL BIRMINGHAM / 15 pct.
MASSACHUSETTS GENERAL HOSPITAL BOSTON / 15 pct.
Rheumatologists diagnose and treat diseases of the joints, muscles and connective tissue. Conditions like arthritis and lupus erythematosus can affect other organs in the body, so hospital rheumatology departments cooperate closely with other departments--orthopedics, for example, when decaying joints and bones suggest surgery.
EXPERT'S VIEW
ERNEST BRAHN, assistant professor of rheumatology, UCLA Medical Center: Rheumatic diseases are usually chronic, involving years of treatment. That should orient people toward a hospital that offers a full complement of inpatient and outpatient services. For example, a person may not need physical therapy when he is first diagnosed and begins treatment but may well need it down the road. In addition, you certainly want a hospital that is involved with conducting research and clinical trials of new drugs. Modern radiological equipment is essential, and the availability of diagnostic arthroscopy--which lets doctors look directly into diseased tissue--also indicates care on the cutting edge. People with rare rheumatic conditions need to be seen by subspecialists at a larger teaching hospital.
RESOURCES
The National Institute of Arthritis and Musculoskeletal and Skin Diseases, (301) 495-4484. Basic information and lists of clinical trials. Arthritis Foundation, (800) 283-7800. Referral to 71 local chapters, which in turn refer to rheumatologists, clinics, special programs, vocational training, counseling and support groups in your area.
UROLOGY
MAYO CLINIC ROCHESTER, MINN. / 43 pct.
JOHNS HOPKINS HOSPITAL BALTIMORE / 38 pct.
UCLA MEDICAL CENTER LOS ANGELES / 25 pct.
CLEVELAND CLINIC / 24 pct.
MASSACHUSETTS GENERAL HOSPITAL BOSTON / 21 pct.
DUKE UNIVERSITY MEDICAL CENTER DURHAM, N.C. / 20 pct.
UNIVERSITY OF TEXAS (M.D. ANDERSON CANCER CENTER) HOUSTON / 16 pct.
MEMORIAL SLOAN-KETTERING CANCER CENTER NEW YORK / 13 pct.
STANFORD UNIVERSITY HOSPITAL STANFORD, CALIF. / 10 pct.
UNIVERSITY OF WASHINGTON MEDICAL CENTER SEATTLE / 9 pct.
Most urology departments focus largely on the prostate, a walnut-size gland in men beneath the bladder that can become cancerous or may enlarge and block urine flow. Urologists also deal with other disorders of the male urinary tract and reproductive system and with problems of the female urinary tract.
EXPERT'S VIEW
PATRICK WALSH, urologist in chief, Johns Hopkins Hospital: Many urological problems, such as cancer of the prostate, bladder and kidney, and urinary incontinence, don't rely on high technology but on ability and compassion. The doctor has to share the patient's concerns--not just whether he is going to die, but if you keep him from dying, what will be the status of his urinary tract, his sexual function, his self-esteem? With a problem that calls for surgery, you want not only someone with a great reputation as a surgeon but someone who shows compassion. You may have the world's best surgeon, but if he is not caring I wouldn't want him for my doctor.
RESOURCES
The American Foundation for Urologic Disease. Booklets on urologic diseases, (800) 242-2382; information on prostate cancer support groups, (800) 828-7866. National Kidney and Urologic Diseases Information Clearinghouse (Box NKUDIC/BPH, Bethesda, MD 20892). New booklet on prostate enlargement.
This story appears in the June 15, 1992 print edition of U.S. News & World Report.