Our organization, like most health care providers, is working hard to improve the care we provide to our patients, while also striving to improve the lives of our physicians. All too often, a narrow view of the former can create conflict with the latter. For example, a reductionist view of clinical quality, which equates good care with performance on a small number of “objective” measures like mammography rates and hemoglobin A1C levels, is often dispiriting for physicians. Of course physicians understand the importance of breast cancer screening and glucose control in diabetes. But they also understand that there is much more to good care. They are justifiably demoralized by the implicit devaluation of the human connections between patients and doctors – the very essence of good care — that these measures can’t capture.
Steven Brill made a name for himself with an article in Time magazine back in 2013 entitled “Bitter Pill,” in which he harshly criticized how health care providers (especially hospitals) inflate the costs of their services. The piece created a lot of buzz, and some backlash from hospital groups and others. Now it seems that Mr. Brill has had a bit of a “sick-bed conversion.”
He has a new piece in the January 19th issue of Time called “What I learned from my $190,000 open-heart surgery: the surprising solution for fixing our health care system.” Since Time won’t let you read the article without subscribing or paying, I will save you the trouble. It seems that what he learned is that health care providers – the same ones he vilified in 2013 – were pretty great when they were taking care of his heart in 2015. In fact, he now believes that the way to “fix” healthcare is to “let the foxes run the henhouse” by allowing large integrated health systems become insurance companies and compete on price and “brand” and regulate their profits to assure that they are acting in the public interest. Yeah, well, no kidding.
As I have noted previously I have a “love-hate” relationship with practice guidelines. Love because it is often helpful to refer to a set of evidence-based recommendations as part of clinical decision-making; hate because of all of the shortcomings of the guidelines themselves, as well as the evidence upon which they are based. Continue reading Practice Guidelines and Quality Care