Tuesday, August 10, 2010

The "I'm Weak" Lamentations of Physicians Over Quality Measures in the New England Journal of Medicine

"I'm weak!" says the Disease Management Care Blog.

Over the years, that short sentence has served as the perfect neutralizer to unwanted responsibility, conveying a perfect combination of victimhood, martyrdom and passivity. When used at the right time, it works so well, the DMCB wonders why it's not used more often, like when corporate titans succumb to temptation, or when politicians get caught making stuff up or when the AMA has to grovel for an SGR fix.

Unfortunately, the argument has generally failed to make the DMCB spouse show any mercy. She suspects the DMCB's claims of feebleness are merely a cover for its unwillingness to hang up its clothes or stop channel surfing until it finds the most tasteless show on TV.

The spouse would probably feel the same way about Danielle Ofri's New England Journal article (here's the link) titled "Quality Measures and the Individual Physician." Anyone who has read about the travails of individual physician performance measurement and feedback will probably recognize all of Dr. Ofri's lamentations about being simply unable to live up to its expectations. They include:

Over time, the numbers typically don't budge.

Over time, physician behaviors don't budge

Over time, the only thing that does budge is physician morale, and that's downward.

In the end, physicians are already trying hard and the numbers add little to their motivation.

After awhile, physicians stop paying attention.

The numbers may be unequal to the task of measuring true quality, not to mention the "art" of medicine

The numbers fail to discern between being just missing a quality measure threshold and having disease that is dangerously out of control.

It's difficult to worry about simple quality measures when patient's real world needs are far greater.

It's too easy for patients to misinterpret the numbers

What could be done to improve the numbers is out of reach in most physician's offices

The DMCB feels Dr. Ofri's pain. Unfortunately, something has to be done and vacuum of physician inaction has predictably led to the intrusion of multiple outside organizations horning into day-to-day clinical practice. There are other solutions at hand, including partnering with disease management or starting a patient centered medical home. Both can liberate physicians from personally handling the details of office-based quality improvement.

The good news is that there are plenty of docs that get it. As for the ones who don't, the "I'm weak" style lamentations of Dr. Ofri will get those docs about as far as the DMCB has gotten with the spouse: no where.

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