The work by Dartmouth University medical researchers represents the first attempt to take stock nationally of how well the health care system serves patients at the end of their lives. The Dartmouth study reinforces criticism that the amount of care patients receive in their final days has little to do with their preferences. In medicine, as in real estate, location turns out to be everything. The more profound implication is that millions of patients across the country are routinely subjected to risky surgery and invasive procedures without medical justification. This West Texas city of 200,000 has become the heart-care industry's El Dorado.
Cardiologists here are rich enough to buy Cessna jets and breed Arabian horses.
People with weak hearts, sore backs or breast cancer may think their symptoms alone decide their care. To public health experts, such treatment patterns constitute something close to a medical scandal. This matters to patients as well. For ten years now, they've been comparing how doctors and hospitals in various cities across the country treat the very same kinds of ailments. For instance, if you have back problems, doctors in the Northwest are three times as likely to send you to surgery as doctors in the Northeast.