Patients Value Personal Recommendation Over Online Doctor Ratings
Hypothesis: The entire performance measurement field is paternalistic!
Over the past 10 years we (the medical profession) have become obsessed with performance measurement and guideline adherence. We promote "evidence based medicine" as clearly the best way to help patients.
Consider the possibility that in many cases the patient's goals of the medical interaction have nothing to do with performance. Consider that too much focus on "performance" may detract us from patient centered management plans.
Physicians have an obligation to explain options to patients. We even have an obligation to make strong recommendations. But should we tell patients what to do? Does not performance measurement assume that patients desires align with formal guidelines? Is that the right attitude?
One of my colleagues, Dr. Monica Safford, wrote a brilliant paper in 2007 on "clinical inertia". She challenged the assumption that not intensifying therapy was necessarily bad. She strongly considered patient factors in her model.
Patients differ in their expectations of medical care, both short term, but especially long term. As I consider my talk on PCMH and CER, I plan to stress this point. We must do everything with a strong consideration of patient desires.
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Perhaps we are misunderstanding each other semantically, but I associate "performance measurement" with how well processes function to deliver care according to preset metrics. Now, one may dispute the metrics, but I don't consider that 'performance'. I think the patient definitely has an interest in how well you deliver care, although I do understand your point that we may be focusing on the wrong things.
This is why I chose family medicine over internal medicine. When I was a medical student (class of 2000) my internal medicine mentors were more focused on patients as mechanical bodies rather than human, emotional beings (yes, I admit, generalization, but my true experience).
My family medicine mentors, on the other hand, were more focused on the "biopsychosocial model", which almost all medical students treated with disdain and laughter.
Metrics are meaningless when taken out of patients' contexts. Medicine is both art and science.
Metrics are too simplistic for the complexities of genuine patient CARE.
Right on. Wonderful piece
Why would you want to engage patients in their medical decision making and individualize your recommendations when they may choose to deviate from "quality care" as defined by administrators and bean counters? (i.e. people not in the exam room)
Then you'd be labeled a bad doctor when the numbers are all added up.
Avoid mentioning the actual studies, number need to treat, controversies in the literature, etc. Instead, use phrases like "this is important for your health" "You're risking your life" "it's clear what we should do here" "you don't want to have a stroke/MI, do you?" etc.
Doctors who advise patients that way will certainly have better "numbers" and get (force) more people to goal. Whether that's the right way to practice medicine and serve the needs of your patient don't matter.
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