Monday, February 23, 2009
So, if fame, notoriety and prestige are not the prescriptions for choosing a doctor, what should patients do? Check the next posting for some pointers.
Sunday, February 15, 2009
Here’s a list of attributes that define high quality physicians. This is not a controversial posting. After each entry, you will be nodding in agreement that it is an essential element of a high quality physician’s skill set. Here’s the unsolvable challenge. After reading each listing, decide how you could accurately rate a physician on the specific item and compare him to colleagues. I’ve been a physician for 20 years, and I have no idea how to do this. Perhaps, smarter folks can figure this out, since this is where true medical quality can be found, not in mindless, meaningless and downright dumb data and statistics.
Great physicians have many of the following skills and qualities.
- They are skilled at palpating abdomens and hearing subtle cardiac and pulmonary abnormalities with a stethoscope.
- They know when not to prescribe an antibiotic.
- They know when a symptom can be safely observed and not investigated immediately.
- They know whether a CAT scan finding should be ignored or pursued.
- They are expert communicators who sense when a patient harbors an additional concern.
- They have an adequate and current core of medical knowledge.
- They can skillfully manage a medical issue on the phone after hours.
- They understand and counsel that more consultants and tests often mean less care and healing.
- They tell the truth when a patient asks if the surgeon he has seen is the best choice.
- They are compassionate.
Of course, this list could be longer. The point is that what truly defines good and great doctors, can’t be calculated and entered on a spreadsheet. Don’t let the government or the insurance companies fool you on this one. Besides, are these institutions of such high quality that we should trust them to measure medical quality?
On the next posting, some physicians who might be too good to be true.
Saturday, February 7, 2009
The next time you are in your physician’s office, ask about the various government and insurance company quality programs. If any of you find a doctor who supports these programs, contact me STAT and I’ll post your comments.
Next posting, true medical quality which can’t be measured.
Sunday, February 1, 2009
In medicine, there are many facts and figures that can be easily measured. Here are examples of data that is being diligently recorded and scrutinized by medical number-crunchers across the country.
- Hospital deaths
- Volume of hospital and individual physician surgeries and medical procedures
- Average # hospital days for specific illnesses
- % of a physician’s practice who have undergone preventative medical testing
- # minutes the gastroenterologist’s colonoscope spends within the colon (This is not a joke!)
- A physician’s medical malpractice history
- Automobile the physician drives. (This is a joke!)
- # and % primary physician referrals to specialists
- $$ that physician expends per patient per specific medical condition
I could have made this list a lot longer, but you get the idea here. Sure, you can collect and measure all kinds of medical data, but this doesn’t measure medical quality. Since the government and insurance companies have no reliable way to measure quality, they have opted instead to measure what can be easily counted, as if these are actual quality benchmarks. This is the fallacy of these ‘quality’ programs. Consider a hypothetical example. If Physician A has an 80% mammogram rate in his practice while Physician B has a 50% rate, is the former doctor a higher quality practitioner? Not necessarily. What if Physician B’s patients are not health conscious and don’t pursue preventative care? Is this the doctor’s fault? Of course, not, but he may be assigned a lower quality score anyway.
Next posting, what you can learn about medical quality in an art museum!