HIV and ID Observations

As the internet burns through traditional print media, decimating anything paper in its path, several odd things have happened beyond simply putting those newspapers, magazines, and journals out of business. For example, Gourmet was subsumed into Bon Appetit — who could have predicted that? PLoS One and its ilk were born.

And what about the hard-copy versions of the big three news magazines?

• Newsweek disappeared.
• Time has gone on quite a diet, getting thinner every week.
• US News & World Report, the awkwardly named and most serious of the three, initially decreased publication from weekly to biweekly, then to monthly, then stopped entirely in 2010.

That is, US News & World Report stopped publishing a news magazine — it still, of course, publishes the hugely popular rankings of colleges, grad schools, and hospitals, much to the delight (or chagrin) of administrators, marketers, and PR personel everywhere.

In many ways, USN&WR (can’t stand to write out the whole thing again, sorry) has morphed into a Michelin-like guide to the country’s “Best Anything” — take a look at this “Rankings” page — and who knows what they’ll rank next.

They already do high schools, law firms, nursing homes, summer vacations. How about museums, car washes, roller rinks, AM radio stations, salt and vinegar potato chips — the possibilities are endless. They could even rank news magazines, thought that would be a very short report.

As for the hospital rankings, which came out last week, I confess to having a pretty cynical view of the whole enterprise, despite the fact that our hospital does quite well.

(For the record, not this well, mind you, but not too bad. Marketers can’t resist this stuff.)

To explain my skepticism, let me ask some truly obvious questions which have anything but obvious answers: Isn’t measuring the quality of care a particularly tough challenge? What are the outcomes of interest? Survival? Complications? Patient satisfaction? Cost effectiveness? How is the care for the poor and/or uninsured, or the average Jane or Joe, or for the billionaire hedge fund manager or Saudi prince who can go anywhere? Which is more important, how a hospital does with particularly complex cases, or with “routine” care? How long is the average wait for an elevator? (We must have lost points on that one, trust me.)

In sum, who’s to say that the USWNR methodology is the right one?

It’s because of these and other concerns that I’m always relieved that Infectious Diseases is not one of the 16 specialties included in the rankings.

Or maybe I’m just worried that we’d come up short in their ID-specific criteria — our consults lack sufficient pet histories, we recommend too much indiscriminate carbapenem use, vancomycin levels are too low, some HIV patients have no documentation of their PPD status. In a best case scenario, we could use the results to improve areas of weakness, a kind of national quality assurance program that’s only slightly embarrassing.

Plus, wouldn’t listing ID in the specialties give our field some much-needed publicity?

What do you think?