Tuesday, July 17, 2012

How Do You Measure Physician Performance?
How do you measure physician performance?
Should it simply be by computer conformance?
When you measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure, when you cannot express it in numbers, your knowledge is of a meager and unsatisfactory kind.
Lord Kelvin (1824-1907), Popular Lectures and Addresses (1891-1894)
July 17, 2012 -  One of the functions of this blog is to bring attention to the work of other bloggers. One of these bloggers is Westby G. Fisher, MD, (aka Dr. Wes),  a board certified internist, cardiologist and cardiac electrophysiologist who practices  at NorthShore University HealthSystem in Evanston, IL. He is also a Clinical Associate Professor of Medicine at the University of Chicago’s Pritzker School of Medicine. He blogs at Dr.Wes, where this post originally appeared and is now running on The Health Care Blog
“A little box pops up before him asking if he asked the patient about the exercise. He mumbles something under his breath, clicks a little box beneath the question, then moves on.”
“This is what medicine has become: a series of computer queries and measures of clicks. It must be measurable, quantifiable, and justifiable or it didn’t happen.”
“Do they ask if I asked them about if they used cocaine? Of course not: too politically incorrect.”
“Do they ask if I really listened to their heart? Of course not – this activity is not a paid activity.”
“Do they ask about the myriad of phone calls and e-mails to arrange for a procedure? Nope.”
“Do they measure my time with the patient when I go back to see them on the same day? Nope – not paid for.”
“So what’s the motivation for doctors to be doctors? Are we retraining our doctors from care-givers to data providers? What are we losing in turn?”
“An excellent opinion piece by Daniel Henniger appeared in the Wall Street Journal. In it, he references an important article by Drs. Christine Cassel and Sachin H Jain published in the June 17th issue of JAMA entitled “Assessing Individual Physician Performance: Does Measurement Suppress Motivation.” Cassel and Jain are two shapers of the Pay-for-Performance movement but acknowledge the danger this movement has on physician behavior:
Overstating the value of discrete quality measures has the potential to demotivate and demoralize physicians who appropriately view their job as much more than simply meeting a standardized measure set.”
“This point cannot be overemphasized.”
“Doctors are losing their motivation to diagnose in favor of sitting at a computer. Doctors, I also dare say, are losing their skills in favor of sitting at a computer. Clicking buttons has such importance to health care systems that these performance measures are being linked, in part, to doctors’ salaries. As a result, young doctors are losing their complex problem solving skills in favor of making sure they click on every result that comes to their inbox, lest they be seen as nonproductive. This, you see, is what matters to employers.”
“We are reshaping medicine away from the bedside to the computer.”
“We’d better understand the damage this shift is causing before our young physicians of tomorrow don’t know any better.”
I shall express my comment with this simple verse
Payers and data-mongers will not find this thought pleasurable,
But certain physician activities and clinical skills are immeasurable:
The time it takes to solve the patient’s problem,
The knowledge it takes into context to put them.

Forgive me, Lord Kelvin, for my scientific irreverence.
Tweet:  The time and knowledge it takes for a skilled physician to solve a patient’s problems cannot be measured with computer clicks.

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