What should our report cards look like?


Category : General, Medical Rants

I am quoted in this article – so it deserves a link! (insert grin here)

Docs’ Technical Skills Matter More to Patients than Bedside Manner

Participants in the study used report card grades to compare pairs of physicians with opposite strengths. For instance, one pair matched a doctor with high technical skill grades but low personal skill grades against a doctor with excellent people skills and poor technical skills.

For three of five physician pairs, two-thirds of the participants chose the doctor with the better technical skills, researcher Constance Fung, MD, of RAND and colleagues discovered. However, 33% of the participants chose a doctor with an excellent bedside manner in three of the five pairs, “suggesting that interpersonal quality was important for a substantial number of people in our sample,” says Fung, who is also a staff physician at the Greater Los Angeles Veterans Affairs Medical Center.

Patients may be willing to tolerate poor personal skills up to a point, the researchers found. Half of the participants chose the doctor with better personal skills from pairs in which the other doctor was graded low on his or her patient interactions.

The technical skills graded on the mock report cards included care for sickness or injury, ongoing care for chronic conditions like high blood pressure, and preventive care. Personal skills included the doctor’s communication skills, courtesy and respect toward patients, and promptness.

Fung and colleagues told the study participants that the information behind the technical grades in the mock report cards came from reviews of medical chart records and insurance bills, while the personal skills grades were based on patients’ experiences with the doctors.

Participants said they trusted the expert reviews of the medical records more than the patient reports, which may explain in part why they were more apt to choose doctors with high grades in technical expertise.

And based on this information I comment:

Robert Centor, MD, a physician and professor at the University of Alabama at Birmingham who has criticized healthcare report cards in the past, says the RAND study “gets closer” to a report card that measures multiple dimensions of a physician’s competency and skills.

People who want to evaluate a doctor’s quality would want to know if a physician “makes the right diagnoses, uses the right tests and interprets those tests correctly, uses treatments correctly, and understands their contraindications,” Centor says.

“I would also want to know, ‘Does that physician engender a patient’s trust?’ and ‘Does that physician explain to patients what is wrong with them and why he or she is pursuing a certain course of action?'” he adds.

Fung and colleagues say the results of their study “help us understand the choices people might make if they had comparative information about the technical and interpersonal quality of care of primary physicians in their area.”

Unfortunately, the researchers note, such choices only exist in their mock report card study.

While I commend the ideas behind the study, I caution that the artificiality of the study limits our ability to develop firm conclusions from these data. These data provide interesting hypotheses. We need more such studies to better understand the entire report card issue.

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