Imposing regulations without evidence

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Category : Medical Rants

“Experts” consistently champion evidence based medicine.  Policy wonks opine that we could greatly improve patient care if we more consistently followed the evidence.  Evidence has become a major buzzword in health care.

Yet too often regulations impact physicians that have no evidence base.  I have argued against the clinical skills exam for many years.  Please read this Washington Post article about the exam – $1,300 to take one test? Med students are fed up.

How about the method of note writing that CMS inspired?  Does anyone believe that our notes have improved with the billing requirements?

Do these impositions follow evidence?  No!  A regulation body imposes something that has face validity to them, but not to us.

As children we often learn the famous saying – what is good for the goose is good for the gander.  If evidence is really important (and why else do we even consider performance measurement), then we should hold the same standard to these regulations.  We should not have regulations that impact health care imposed without a strong evidence base.

But then the world does not always act rationally.

Comments (8)

MOC is really no different. ABIM must take responsibility for their actions as documented at drwes.blogspot,com. MOC just needs to go away, IMHO

We assume because we live breathe die wake-up and poop scientific methods that other industries must also. This is not the in one HUGE industry and that is the legal profession. Lawyers only think in term of constant flexibility. If it does work tomorrow it might not because some ruled it the other way.
As long as we allow them to oversee our domain we can only expect to have this type of non-scientific result.
Be it CMS, MOC, or EMR as long as scientists don’t stand up and yell ” get out of my expertise” we can ONLY expect more and more disruption. Evidence is only fact to us to them it is opinion. Look at ANY trial. They depose “evidence” from every witness and every recollection is slightly different. If that was science the information would be tossed out as random but to lawyers they rely on it and try cases based on it get judgments.
We need to retake control and not use science to prove our needs but to simply exercise our independence otherwise we refuse to continue to treat society. That will quickly and permanently lay the opposition down to the rules of the road.
We don’t try to alter their rules yet we allow them to daily alter ours. Ever seen a physician stepping into how lawyers practice or try cases or deal with juries or judges? Why then do we allow them to alter how we treat patients and practice as a whole.
Dr D

Since we the taxpayers bankroll the salaries of politicians and CMS administrators, why don’t we develop an outcome-based “incentive” program for such employees of the public?

I absolutely love this idea! With your permission, I would like to tweet it.

Please do. My Twitter name in @endodocPA
Let’s spread this idea far and wide. Allow public (our patients) to rally to this cry. Even better would be to set up an online petition with just this one demand. How about that?

Evidence based-medicine was hijacked early on by people with other agendas. Sackett did not see that coming, but he should have.
In reality evidence-based medicine is just a new way of saying read the literature carefully. But those with an agenda, inside and outside of medicine turned it into a billion dollar industry and a powerful political tool.
Remember the word “evidence” comes from the Latin “videre” – to see. But looks can be deceiving. And eyewitnesses are often mistaken.

well said

As much as I like the idea of P4P in the public sphere, I doubt any positive efficacy. The problem of financial incentives for medicrats can be seen with the (recent) VA system scandal. Rather than improving care, many of the bonus recipients gamed the process.

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