Contextual errors – impact on quality


Category : Medical Rants

My friend and colleague, Stefan Kertesz, has a wonderful blog entry over at Huffington Post today – Physician Errors: How our Health Care System is Failing us

A quick look at quality measures used by the federal government, and disseminated by major health care organizations, reflects a sadly mechanical vision for quality of care.

The measures focus narrowly on whether physicians prescribe certain drugs, run certain tests, or get certain health problems under control using strict numerical measures. The measures reflect the algorithmic, rule-bound view of care promulgated by conventional health care guidelines. In this view, every problem can be met with a new prescription, an increased dose of the old prescription, or a new test. In recent years a new body of research has emerged to explain why doctors don't raise the doses on medications fast enough. Failure to do so is called "clinical inertia."

The medical residents I train have learned these lessons all too well. They tick through checklists of tests and medications faster than I ever could. But when I ask them why the care is not working, very few have the slightest clue. They rarely even know what questions to ask.

As this recent study shows clearly, new doctors are not well trained to listen with an openness to the kind of information that nearly every doctor agrees totally change the plan of care. And sadly, our system of medical education has been, in the main, passive in response to this challenge. We try to teach students to listen, but we don't show them how to listen for what matters.

And that challenge eats at the heart of today's health care quality industry, and its laudable objective of "value-based health care." It's also the source of a great deal of patient frustration.

A blizzard of mechanical quality measures, promulgated by insurers and the federal government, is actually distracting us from making good clinical decisions. The promise that we'll all be able to shop for "value" in health care will be undermined unless all of us who work in health care change the way physicians think about quality, and measure it. And that won't happen until patients demand it.

Stefan provides a brilliant summary of a most important paper.  This study and his commentary complement my recent posts perfectly.  Bravo!

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