Tuesday, July 20, 2010

The Error In Our Ways

It seems doctors can never do enough. Not only must we diagnose and treat medical illness, this morning in the Chicago Tribune we learn from a study in the Annals of Internal Medicine that used actors posing as patients that seventy-eight percent of doctors make medical errors because we obtain no "contextual history" (another word for "social history?") and adjust our treatment strategies accordingly:
"A lot of doctors are going to say, 'God almighty, it's not enough to be a brilliant clinician? You're telling me I've got to be a financial counselor or social worker on top of that or I'm doing something wrong? Give me a break!'" said John Banja, a medical errors expert at Emory University.
Of course, the lack of social history (or many other aspects of the patient's history) is the predictable consequence of shortened office visits, increased administrative burdens, shift-style medical care, and the push to see more patients in less time. It's hard to cover all the bases in seven minutes.

One thing I'm sure of, however, is a doctor's time with a patient is finite. For every click on a computerized quality check-box, we're stealing from the face-to-face time with the patient. Instead of appreciating this fact, our governmental overlords have consistently swollen the number of "quality measures" from 74 in 2007, 119 in 2008, 153 in 2009, to a whopping 179 in 2010. I figure at this rate, using linear regression, we will have about 319 measures by 2014, the same year another 30 million uninsured will be joining our new health care system.

And the government will be proud we're providing such "quality care."

Click. Click. Click.

Never mind these "quality" clicks might just be doing more harm than good.



DrJohnM said...

And now three forms to do an ICD...

And more review of symptoms bullet points...

Worse yet, doctors-in-cubicles who ask me, "what's going on with your patient?" Well, for starters, I am seeing the patient.


Thanks for so clearly pointing out the obvious.


jimbino said...

Would you have all these distractions if you canceled all involvement with insurance, Medicare and Medicaid and just started seeing patients, like me, who pay $1 cash for a dollar's worth of medical care and don't care to deal with or subsidize insurance, Medicare, Medicaid, or credit card fees?

Or do what patients are starting to do: head overseas for good, no-hassle, medical treatment like we used to have in the USSA.

Anonymous said...

Can you imagine the plight of primary care doctors who are underpaid and overburdened every minute of the day with paperwork and handling all sorts of social issues. In our hospital when we need a cardiac intervention as In-patient, interventionalist arrives on time, does his thing and goes. The primary care team, the non invasive cardiologist do everything including education,consent form.