Practice makes perfect: who knew?

Men with aggressive prostate cancer are more likely to survive if they receive radiation therapy at a hospital that provides the treatment to a large number of patients, researchers report.

Bit of a surprise, isn’t it?

Not like we’ve not found that in all sorts of medical treatments? Or perhaps some still think that getting the day release lad in is going to work better?

15 thoughts on “Practice makes perfect: who knew?”

  1. That’s similar to my support for large(r) schools over small(er) schools – you have the breadth of experience and resources to cope with varied situations. And if you’re a 1% oddity in your school in a small school you’re a loner, in a large school there’s a couple of others like you.

    And “large schools” does not mean “large classes”. There’s too much campaigning for small schools by people thinking they are campaigning for small classes. Small schools makes it harder to have small classes as you don’t have the numbers to have the flexibility in class numbers.

  2. This effect is very common in medicine.

    But try telling the great British public that there shitty NHS ‘local’ hospital probably should be closed or reduced in size and such treatments moved to a central large hospital where the treatment will be better, and all hell will break loose.

  3. So Much For Subtlety

    There is a hospital in Canada that has specialised in one particular surgery. I would like to say a hip operation but it isn’t. Something anyway. Surprisingly they find they are much faster, and better (in terms of few complications and lower costs) at it. Who would have guessed?

    I would think the main obstacle is that it is boring for doctors and a blow to their ego. They would rather see themselves as the master of all before them.

    jgh – “That’s similar to my support for large(r) schools over small(er) schools – you have the breadth of experience and resources to cope with varied situations. And if you’re a 1% oddity in your school in a small school you’re a loner, in a large school there’s a couple of others like you.”

    Whereas I disagree for more or less the same reason. In a big school you are always a stranger and so will be the crap pounded out of you by someone on a regular basis. At best you get beaten in company. In a small school everyone knows you and so you have some friends no matter how weird you are. Small private, especially boarding, schools are vastly more tolerant of oddity than large government schools.

    Andy – “But try telling the great British public that there shitty NHS ‘local’ hospital probably should be closed or reduced in size and such treatments moved to a central large hospital where the treatment will be better, and all hell will break loose.”

    But the two are not mutually exclusive. America in Iraq found that they improved outcomes if the doctors in the front line stabilised the patient and then moved him up the feed chain. At each point the local medical team decided if the injury was minor enough for them to treat or if the soldier should move further up. The serious injuries went all the way to Germany. It really did work.

    The NHS does not like paying for doctors to live in small out of the way places. So they want everyone to be in London because their wives can shop at Harrods.

    There is a sensible solution – which is a small local hospital which evaluates a patient and if it is a serious problem they send them to the nearest big hospital. This requires doctors to fight their egos and for the NHS to give a damn about patients. So it ain’t gonna happen.

  4. I know there’s a fair number of people here that hate the DamnCommunists, but I do remember that there was a fair amount of assembly-line approach in their medicine, especially the “standard minor” procedures like cataract removal and that kind of stuff.

    Similar things are done for minor surgeries in the Netherlands: a set of theatres is dedicated to one type of operation on a [choose day] doing only that. vasectomies, cataracts, hips, knees, and indeed, also chemo/radiation.
    It’s….impersonal.. but it beats losing time rerigging/preparing a theatre for each specific operation.

  5. SMFS suggested:
    “a small local hospital which evaluates a patient and if it is a serious problem they send them to the nearest big hospital”

    Isn’t the problem there that the small local hospital will, if it’s short of work, treat patients it should have passed on to keep its income up?

    Or if you pay them regardless, it’ll pass on too many to keep its costs (or workload) down.

  6. So Much For Subtlety

    Richard – “Isn’t the problem there that the small local hospital will, if it’s short of work, treat patients it should have passed on to keep its income up?”

    Well if the NHS has any benefit at all it should be managing these sort of problems.

    “Or if you pay them regardless, it’ll pass on too many to keep its costs (or workload) down.”

    That is true. But it is the route that the government is going. Only they call their small local hospitals “polyclinics” or some such term.

    It could be simply enough to deal with this though. Separate diagnosis and treatment. The clinic works out the problem. Sends them to someone else for the operation. Even if, for minor problems, they are in the same building.

  7. SMFS said:
    “Well if the NHS has any benefit at all it should be managing these sort of problems.”

    That’s a big “if”.

    Wasn’t that its purpose – to manage and co-ordinate healthcare properly and, by encouraging efficient use of preventative healthcare, to reduce overall costs? Envy of the world, or so they say.

  8. @SMFS “small hospitals”

    Conversely, the British experience in Afghanistan was to abandon the traditional concept of passing wounded back through regimental aid posts and instead fly medical expertise to the point of wounding and take the wounded straight to the hospital at well equipped hospital at Camp Bastion for initial lifesaving surgery. Patients were then flown to Birmingham to receive further lifesaving treatment and eventually reconstructive treatment.

    The distances involved forced having a hospital at BASTION.

    Within the UK, the approach is very much for paramedics to bypass local hospitals and go straight to the specialist centres. For example, stroke and heart attack patients should bypass A&E departments and go straight to Hyper Acute Stroke Units and Cardiac Catheterisation Laboratories respectively. A key reason is that the effectiveness of the main treatments depends on time since the initial onset of symptoms.

    The regional Major Trauma Centre concept works, even in a large area like Scotland. Even though it might take you 40 minutes to get to a MTC vs 9 minutes to the local A&E, it is actually far quicker as it can take a couple of hours for the local A&E to stabilise a patient and organise transport to the MTC.

    Predictably there’s a lot of opposition to centralising services like this, even in the face of overwhelming clinical evidence. Not least from those running the small departments who enjoy being the big fish in a small pond.

  9. Bloke in North Dorset

    “Predictably there’s a lot of opposition to centralising services like this, even in the face of overwhelming clinical evidence. Not least from those running the small departments who enjoy being the big fish in a small pond.”

    And that sums up the problems politicians face when it comes to the national religion: Emotion >> logic

  10. Not convinced by the similarity between hospital and school. Schools should be personal places. If staff or student sees X misbehaving, it helps to have some idea who X is, which form X is in, etc. Otherwise X can leg it and you’ll never find out who X was. Smaller schools are easier to control for that reason.

    Hospitals, on the other hand, benefit from being impersonal. There’s little worse than living in Little Nowhereville, where you know half the staff at the medical centre personally. Size is ok, up until the point that it becomes difficult to exert effective managerial control.

  11. Up to a point Lord Copper.

    If you regard human beings as cars then yes. Trouble is they’re more like weather systems. The problem comes when the treated patient becomes Neutropenic septic or develops a pain flare after radiotherapy or other complication. That needs treated there and then and can’t wait for a 100 mile transfer.

    But the general point is a no brainer. As a commenter points out above, try getting the public to agree to closing a local hospital.

  12. Tommy:

    When you’re wounded and layin’ on Afghanistan’s plains
    And the women come out to cut up what remains
    Then roll to your rifle and blow out your brains
    And go to your god like a soldier.

  13. “For example, seven-year-survival rates were 76 percent among patients treated at facilities in the top 20 percent of patient volume (more than 43 a year). This compared with 74 percent among patients treated at facilities in the bottom 80 percent of volume, according to the study. ”

    So the magic difference was 76% big’n’frequent vs 74% at tiny’n’rare?? No confidence limits quoted, but that really doesn’t seem like enough to affect decision taking or treatment/hospital ranking very much.

  14. @ MyBurningEars
    Thoroughly agree – although the ability of individual teachers to recognise and remember children varies enormously – the Headmaster of my Prep School, who was a brilliant treacher, told us that no school should be larger than 300 children as that was the maximum number of children that a headmaster could know as individuals.

  15. My school experience as a pupil and a governor was at a big school that was split into a lower school and an upper school, each with its own teaching/admin structure. 2 years x 12 classes in lower school, 3 years x 13 classes in upper school, 2 years x 3 classes of 15 in 6th form. (That should add up to about 2000) So it benefited from the spread of experience from being a large school, and also benefited from the insularness (that’s the wrong word, but bear with me) of being a small school. Children moving in from primary school weren’t faced with being in an impersonal 2000-pupil environment, they were in their ‘own’ smaller school with staff who knew them.

    Things changed significantly when the pupil bulge passed through and numbers dropped. The council abolished the sixth form, gave the lower school buildings to the neighbouring college and moved the lower school years into the same building as the upper school years. Overnight it went from effectively a 700-pupil school and a neighbouring 900-pupil school into one 1500-pupil school with all the overcrowding, mass movements and impersonalness of being in a big school. 11-year-olds were herded together with near-adults. Experienced teachers who happily taught ‘o’ levels because they were also teaching ‘a’ levels moved on to the college. Bullying increased, pupil achievement decreased. We had about three years where supply teachers outnumbered permies. Things only started to turn around when so many parents had decided to send their children elsewhere that the school had dropped to about 500 pupils.

    Big schools work /if/ they are organised properly.

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