State-of-the-Art Medical Treatment: Demand It

By Rusty Hofmann, MD
November 15, 2013

Grand Rounds co-founder Dr. "Rusty" Hofmann

Here’s my latest article for the Huffington Post.

Have you seen those AT&T commercials where a guy sits around with a group of children asking either-or-questions, like “What is better? Fast or Slow” and “Which is better? Saving money or not saving money?”

In terms of health care, what if I ask you: “Which is better? Standard-of-care or state-of-the-art care?” I’m pretty sure you would agree that standard-of-care is good, but state-of-the-art care is better–especially if you’ve just received a life-altering diagnosis. However, the term standard of care is actually a legal standard. If a doctor’s care is below the standard-of-care, they can be sued for malpractice. So this bar is actually the floor in medical care. State-of-the-art-care is the ceiling.

I’m not saying standard-of-care is ineffective; it can be quite effective for many. But after being diagnosed with a serious illness, most people want to explore all options and determine if traditional treatment versus state-of-the-art treatment is right for them. But what does state-of-the- art care really mean? How does one get it?

While there is no industry-wide definition of state-of-the-art care, it can be loosely defined as innovative, cutting-edge, and often beyond “the norm” of traditional treatment. State-of-the-art care can be applied to technology, practices and physicians.

For example, a colleague of mine is the only one in the world who can remove an imbedded inferior vena cava filter (a medical device inserted into the heart) via a laser. The alternative means of removing the filter is tricky and dangerous, and as such, people from all over the world are requesting his advice. He is providing state-of-the-art care.

The health care industry is already complex and now, it is in turmoil. Patients need to empower themselves by identifying and demanding state-of-the-art care. Here’s how.

1) Conduct smart research. If you’re looking for state-of-the-art health care, you won’t find it on Yelp. Try to find health care-specific, institution-independent resources to find potentially life-saving treatments for yourself. I like clinicaltrials.gov or pubmed.gov.

2) If you have a close friend or family member that is a doctor, talk to them. After you do your smart research, you may have trouble understanding the medical terms used. Talk to your doctor friend and have him/her explain it to you. Make sure you thank him/her and get them a small gift (bottle of wine), for the time they spent with you.

3) Understand the pace of the health care industry, and plan ahead. The health care industry doesn’t move as fast as, well, much of the world. You can make a $500 purchase on your smartphone in three seconds, but it can often take the health care industry a mindboggling five-fifteen years to adopt a new drug or technology–and that is considered fast. Create your own timeline and if you need to change appointments or procedures later, then do so, but get your health plan going. Consider a friend of mine who was diagnosed with breast cancer last year. Surgeons were advising her on immediate operations, but she knew she eventually needed an oncologist. My friend did her homework and identified the best oncologist in the Bay area. Knowing from other doctors that this oncologist was booked months in advance and it was difficult for her to accept new patients, my friend convinced this doctor’s staff to extend the booking calendar, and scheduled an appointment three months in advance. Had my friend waited until the day, week or even month she needed an oncologist, her ideal doctor would have been unavailable and she would have settled for someone with less pedigree, and perhaps not received state-of-the-art care.

4) Give doctors a break…and a list of questions. I believe all doctors are good and want to help people, but it’s very hard to keep up, particularly if they aren’t specialists. There’s been an explosion of information and medical technology; think how overwhelmed you’ve been Googling, WebMd’ing, etc. Now consider what other resources your physicians receive on a daily basis–do they have access to the latest clinical trial research or the newest CT machine? Depending on your needs and the severity of your case, do you research to figure out what state-of-the-art care is for your diagnosis, and which doctors are practicing it.

5) Visit your nearest large and reputable hospital for top technologies. If you receive a daunting diagnosis, look to larger and more reputable hospitals that have already acquired state-of-the-art care. For example, some of the larger and more reputable hospitals can afford the latest and greatest technologies, like an advanced MRI machine –often several years ahead of hospitals nearby. Actually, academic hospitals often partner with medical device companies to help co-develop new technologies.

6) Find alternative ways to connect to the right doctors. Don’t live in Palo Alto? Cleveland? Rochester, MN? Baltimore? Historically, geography could have prevented you from receiving the highest level of care. But today, anyone with Internet access can utilize a wide range of tools and services to ensure state-of-the-art care. Even if you have to do it from a library cubicle, it’s possible to connect with the world’s leading doctors. Companies like Grand Rounds gather the world’s leading experts in their fields to provide state-of-the-art recommendations on diagnosis and treatments–all through a browser.

I don’t mean to scare you, I mean to empower you. State-of-the-art care may not be right for you, but if your life depends on the right treatment, explore all options. State-of-the-art care is brought to us thanks to the power of technology, and in return we must utilize the technologies at our fingertips to get informed and find the right solutions for our health.

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Rusty Hofmann, MD

Rusty Hofmann, MD

Dr. Hofmann co-founded Grand Rounds with the goal of ensuring that access to state-of-the-art medical care is available to everyone, not just the rich and privileged. He is chief of interventional radiology at Stanford Hospital and a professor of radiology at the Stanford School of Medicine. A nationally recognized deep venous thrombosis (DVT) expert, Dr. Hofmann has published more than 100 articles on acute and chronic DVT, peripheral arterial disease and interventional oncology. Dr. Hofmann has a BS in engineering and biology from University of Illinois and an MD from Ohio State University College of Medicine and he did his residency at Johns Hopkins, where he was chief resident.


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