If John lives in Dallas and has a sudden cardiac arrest, he is twice as likely to die as Bill, who experiences the same symptoms in Portland, Ore.
For many illnesses, the quality of medical care you receive depends on where you live. What causes this variation?
• Patient factors: Believe it or not, personal habits such as smoking, consumption of red meat and exercise may vary by geography. These habits affect the health of inhabitants.
People of certain ethnicities or nationalities may also dominate the population of some regions. The national origin of a region's inhabitants also plays a role in health.
Osteoporosis, for instance, is more common among descendants of northern Europeans, so back surgery is more common.
Even if ethnicities vary widely, many people may share the same type of employment because one industry dominates a region. If that industry requires strenuous work, back surgery may also be more common.
• Health care systems: If surgeons earn more money for doing more operations, there is an incentive to do more surgery. A fixed salary might shift this balance.
If people are allowed to request surgery whenever they wish, there may be higher rates of surgery.
Suppose your region offers an attractive lifestyle and income potential. That will lure specialists who can provide greater expertise.
• How doctors practice: The quality of health care depends mostly, though, on your doctors' choices and their understanding of research.
When a primary care doctor refers a patient to a specialist, the choice of specialist makes all the difference.
If a man with prostate cancer is referred to a radiation expert rather than a surgeon, the patient will likely end up having radiation treatments. But is that the most effective treatment?
General practitioners must know which treatments provide the best outcomes. Yet they are not always up to date on the most effective treatments or tests. Obviously, in some cases, there is no good evidence as to which treatment is better. Knowing this will also help your doctor make recommendations.
You should understand how your doctor's decisions can affect your care. Your life may depend on it.
Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Reach him at drwilkes@sacbee.com.
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