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'Critical Condition,' Unsettling Checkup on U.S. Health Care

Television * Documentary shows that getting well involves much more than just fighting disease.


When his longtime physician retired recently, Pulitzer Prize-winning journalist Hedrick Smith had to go looking for a new doctor.

Smith is producer and narrator of "Critical Condition," a new documentary on the state of U.S. health care, which airs Wednesday on PBS.

"After the reporting I did on this series, I decided that I wasn't looking for a doctor, I was looking for a team of health care providers," said Smith, a former correspondent for the New York Times, from his home in Chevy Chase, Md.

"That means you need an institution that is really strong," he said. "So I picked the best, and it's not here, it's in Baltimore. It's Johns Hopkins."

Now it takes an hour to drive to his doctor's office instead of 15 minutes. But Smith believes that if he ever enters a hospital for treatment of a life-threatening illness, he'll receive the best medical care available in his part of the country.

That's hardly the case for tens of millions of Americans, according to "Critical Condition." One obvious reason: 44 million Americans have no health insurance and cannot afford regular medical care, although 88% are employed.

"Most of them are involuntarily uninsured," Smith says. "Their employer doesn't offer insurance, but offers wages so low that health care comes behind food, shelter and even entertainment."

What is even more shocking to Smith: Many people with health insurance don't use it to their best advantage.

He learned, for example, that people with insurance plans that let them choose their own doctors often pick those who are nearby or who offer the most convenient office hours.

They should be selecting the best physicians in their specialized fields of medicine, Smith says, and making plans so that when the time comes, they'll be admitted to hospitals with the highest rates of success in the areas where they live.

"Don't have your heart operation done, your pneumonia treated, your diabetes treated by someone who does it only occasionally," he says adamantly.

People should also be looking into health care plans that have a record of not refusing to pay for crucial tests or limiting necessary follow-up care as a means of cutting costs, he says. In a country where nearly one-third of the population--100 million people--have a chronic illness of some sort, this is particularly crucial.

He suggests that many people would never take their car to a backyard mechanic. Yet they might go to a doctor who performs only a dozen heart surgeries a year, when they could pick a physician who does 200 operations "Don't have your heart operation done, your pneumonia treated, your diabetes treated by someone who does it only occasionally."


annually and knows how to handle complications.

And that's a simple key to survival, Smith says, noting industry figures that indicate some 98,000 people are killed by medical mistakes each year.

One of the show's most gripping segments examines the case of Claudie Holbrook, a Korean War veteran who died at 67 after he was given the wrong dosage of a blood-thinning medication at a Veterans Administration hospital in Lexington, Ky.

According to "Critical Condition," Holbrook's case was unusual because the hospital admitted its mistake and the family settled for a nominal sum of $50,000.

"If they hadn't come forward, I would have wanted millions," said Sandy Reynolds, Holbrook's daughter.

Such honesty in the profession is rare, according to "Critical Condition," which notes that only three states--New York, New Jersey and Pennsylvania--even require the publication of hospital death rates.

Equally rare, according to the report, is any effort by the medical profession to track its own mistakes and practices.

"In the past, I was an autonomous individual, accountable only to God and myself. I would tell you how good I was by my recall of how well I did for my patients," Dr. Brent James of Salt Lake City tells Smith.

"The difference is today we are measuring it," says James, now a leader in the medical field's quality control movement. "And we are discovering that we are not nearly so good as we thought that we were."


* "Critical Condition" can be seen Wednesday at 8 p.m. on KCET-TV and KVCR-TV.

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