MD Whistleblower

If it were easy to know how to choose a good physician, then everyone would have one. As discussed in prior postings, it’s tough just to define a good doctor, let alone find one. There is no surefire way to select a high quality physician. Methods and advice that sound like a winning strategy, just don’t reliably deliver. For example, you are ecstatic to have an appointment with a renowned doctor at a prestigious medical center, but his fame might be from rat research, not from patient care. You feel privileged to consult with a medical school’s chief of surgery, but it may be residents and other training physicians who are actually doing your operation. You feel fortunate to have an appointment for your asthmatic son with a specialist who lectures widely on lung diseases and has authored several textbooks. However, he might be a much more skilled writer and public speaker than he is a treating physician. You are reassured that your cardiologist is a wizard at placing stents in clogged...

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 pursue...

You have reluctantly left the blogosphere bubble for an afternoon to view a special exhibit at an art museum. You join a crowd who is gawking at a towering marble sculpture. Is it a true masterpiece or simply the work of a talented local art student? How do you accurately assess the work’s worth and quality? Even art scholars may not be able to agree on the piece’s value or if the work is counterfeit. If there is no sure way to measure its value, should we resort instead to using the sculpture’s weight as a quality surrogate just because it is easy to measure? This is ludicrous, but this is exactly what’s happening in the medical field. Let’s not resort to misleading and inaccurate methods of measuring medical quality because we haven’t figured out yet how to do it right. Each year, physicians and hospitals are subjected to still more ‘quality’ initiatives which burden the medical community without improving medical performance. After 3 years of participating in Medicare’s PQRI (Physic...

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 inste...

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 tw...

Medical quality is like pornography, it's hard to define but we know it when we see it. Every participant in the health care arena - physicians, pharmacists, insurance companies, hospitals, pharmaceutical companies, our government and the public - all support the mission to enhance medical quality. What paralyzes the effort is that no one agrees how to get there or even how to accurately measure medical quality. You can test this yourself. Ask your friends and relatives about the quality of their physicians. You will likely receive glowing testimonials about their 'excellent' physicians. Yet, if you ask the important follow-up question, How do you know your doctor is so good?, then your smooth talking neighbor may start stuttering. Don't be too hard on him. If quality experts can't figure out how to assess medical quality, then I doubt that your neighbor or your Aunt Mathilda can do better. Here's a sampling of tips from 'experts' on how to select a hig...

I was flummoxed that the man designated as my trained surgical assistant needed me to ‘talk him through’ the procedure. I wonder if he would be willing to be ‘talked through’ flying an airplane or defusing a bomb for the first time. I’m sure that the patient’s family seated nervously in the waiting room would be reassured by his brash confidence to proceed on their elderly relative. Was I nervous? Not at all because I knew that this man wasn’t going to touch my patient. I relieved him on the spot and arranged for the procedure to be performed by an individual trained to do so. What if I had decided to ‘talk him through’ the procedure? What if he didn’t disclose that he was inexperienced? How much do patients really know about the competence of their physicians and those who assist them? Studies have shown that most patients believe that their personal physicians are highly qualified, but how do they really know this? The scary truth is that they don’t and they can’t. Even experts in qu...