I am concerned by the conclusion reached by Ruhee Chaudhry and colleagues that patients who underwent surgery for breast cancer tumours smaller than 20 mm in diameter experienced better survival if they were initially seen in teaching hospitals rather than community hospitals.1 I could not help but detect a degree of bias in this study against physicians in nonteaching hospitals. Statements such as “teaching status may affect patient outcomes directly because of better knowledge and skills” imply that surgeons in teaching hospitals are superior to those in community hospitals; this has no foundation in fact.
I agree with the authors that differences in patient outcomes between the 2 types of hospital need to be analyzed. If there is a factor that differentiates patient survival in the nonteaching versus teaching centres, it needs to be detected and addressed. If differences in outcome are “artifact[s] of misclassification,” this study needs to be expanded to confirm or refute this point. In the meantime, however, let us not fall into the trap of publishing articles such as this that are biased and will have a limited role in improving health care for Canadians.
Signature
Robert J. Fingerote
Gastroenterologist Queensway-Carleton Hospital Ottawa, Ont.
Reference
- 1.Chaudhry R, Goel V, Sawka C. Breast cancer survival by teaching status of the initial treating hospital. CMAJ 2001;164(2):183-8. [PMC free article] [PubMed]