This article in the WSJ shows how far we have to go to change the way we think about improving healthcare in the U.S. The following are some quotes from the article and my comments. Read the whole article at the end of my blog.
"I am an ear/nose/throat specialist. Maybe 40% of my referrals were initially misdiagnosed" This editorial has shame and blame plastered all over it. The blaming of the doctors who refer him patients but no recognition of the thousands of patients that primary care doctors have treated appropriately and therefore,never got to him. Is his data accurate? "maybe 40%", has he ever measured this or it just a gut thing?When I practiced medicine I thought I did a wonderful job of controlling cholesterol levels in my patients with heart disease until I actually pulled out the charts on each of them and found only 26% were meeting goal.Once I had the data I worked hard to improve the result to 80% meeting goal in six months. I used something called a protocol which this doctor says is cookbook medicine.If I were the patient give me the cookbook please.
"As a specialist, I have better equipment to diagnose illness. I have better cure rates than others because I am able to actually see what is wrong with patients using in-office fiberoptic cameras, CT scans and audiologic testing. I can use these test results, along with elements of the patient's history, to show the patient that his ear pain is temporomandibular joint disease and not an infection, that his sinus problem is actually migraine, and that his throat infection is a manifestation of reflux. I can spend more time with patients because I can charge for these tests". Wow,spend more time with patients because he can charge for tests? That presumes if he didn't charge for tests he wouldn't spend much if any time with patients. what about better cure rates? Compared to whom? Where can I access this data? I want to go to the doctor with best cure rates,what diagnosis is he talking about? How many patients has he seen with these diagnosis and how does he know his cure rates are better than any other ENT specialist or for that matter better than the primary doctors he claims send him inaccurately diagnosed patients?
"I challenge you to tell me that I am more expensive in the long run than weeks or months of inappropriate treatment for incorrect diagnoses". I would only know if you were more expensive if I could compare a series of claims data on each patient you care for by specific diagnosis. In Wisconsin because of the data base created by The Wisconsin Health Information organization we could tell you how you compare to other doctors managing the same episode of care.But at the moment, in Georgia, there is no data base like Wisconsin and therefore it is pure speculation his care is more cost effective.
"I am successful because of the market forces which Dr. Berwick condescendingly dismisses. Medicine is truly an art. Dr. Berwick's ideal health-care system will only replace our current rationing of health care from those who have insurance and money, to rationing by government bureaucracy". As you can read on this site I am a big fan of market forces driving better healthcare value. I am also a major proponent of improving the process of care because medicine is far from purely an art. Most processes by which we deliver care are broken as evidenced by the 100 million medication errors which occur each year in the U.S.as well as many the other errors. We address both market forces and process improvement in detail in our recently published book "On the Mend".
The author's final conclusion is also flawed.He suggests that Berwick's going to ration healthcare. That's simply wrong. Berwick is one of the nation's true experts in quality improvement and clearly understands that removing waste and improving quality is the way to reduce cost. If healthcare providers could actually become engaged in improvement we would never need to ration anything. So if we'd just let Berwick do his job the country's journey of healthcare improvement could begin and we would begin to see better cost and quality across the industry.
Let's stop the shame and blame,start basing our comments on data rather opinion and get this country focused on reducing unnecessary utilization improving inefficiency and creating a better patient
To read the article, click here - http://online.wsj.com/article/SB10001424052748704913304575371210975895460.html
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