Saturday, January 24, 2009

Measuring Physicians' Performance

Over the years I have had countless conversations on how to select a competent physician. Advice on this issue is easy to find, but the desired result is more difficult to achieve. In the last posting, I listed many of the recommendations of ‘experts’ and indicated the pitfalls of their advice.

The New York Times recently published a column offering their advice on choosing a physician. If you review the piece, make sure to peruse also through the deluge of readers’ comments, including one from your humble blogger.

While the Times piece is informative, it does not offer a surefire prescription for selecting a high quality physician. There simply is no easy formula to assess physicians’ competence, like the magazine Consumers Reports might use to rate microwave ovens. Nevertheless doctors are being evaluated and compared by insurance companies, employers, the government and now even on Angie’s List! The reason that this task is so challenging, and the results so suspect, is because two fundamental questions cannot be answered accurately.

What is the definition of a high quality physician?

How do you measure this objectively?


Consider these questions yourselves. How would you answer them with regard to your own physicians? Prepare a list of what you think constitutes medical quality in a doctor. How would you measure the attributes you selected? You will soon discover that there is no simple yardstick to measure medical quality. Doctors are not like microwave ovens or kitchen appliances.

I've struggled for years to answer the above two questions, but I can't solve it. In the next postings, I’ll explain more about this conundrum.

4 comments:

dan borison said...

nice blog!! (i think i'll get a fish tank for my waiting room).
dan borison

Buckeye Surgeon said...

Welcome to the wonderful of blogs Michael! I stumbled across an article that seems to be right up your alley: http://blogs.jwatch.org/gutcheck/

I'd be interested to hear your take.

Anonymous said...

I don't think we will ever have an adequate system to rate physicians and their practices. It is unfair for the government (surprise surprise) to place some kind of a rating on physician care. It is all relative. When my ex brother-in-law was diagnosed with astrocytoma back in 1998, he went to the Cleveland Clinic (undoubtedly world-renowned for "quality care") for evaluation of possible surgical resection. He was told that his cancer was inoperable and that they would "not touch him". They suggested Hospice care and sent him on his way. Thankfully, he decided to get another opinion from The Toledo Hospital and found a surgeon who was willing to perform the surgery. The majority of the cancer was removed and he survived until July 2001, well beyond the timeframe given him by the Clinic. So when we talk about quality of care by physicians and statistics that "make or break" physicians, we are cheating patients. Statistics can be misleading and just because the sign on the door says "world-renowned" doesn't mean everyone is going to be happy with the care they receive.

Janet Mayne

Michael Kirsch, M.D. said...

Janet, Your heartfelt vignette makes powerful points about medical quality. You may wish to see my 2/23/09 posting entitled Are Prestigious Physiicans the Right Prescription? Thanks for sharing your personal and painful story with us. I'm sure it will help others.

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