Friday, September 5, 2014

Sibert Replies to Jauhar

Dr. Karen Sibert has penned a good reply to a recent Wall Street Journal OpEd by Dr. Sandeep Jauhar on the current problems with American health care.

Sibert's piece is entitled, "His diagnosis is right, but the treatment is all wrong". (Jauhar's original piece was, "Why Doctors Are Sick of Their Profession".)

Sibert discusses several important topics, including:

* The truth behind “quality” metrics
* The perils of patient satisfaction scores

She also observes:
Here is what I see as the downhill slide of 21st century medicine:

1.  The surge of uncritical belief in “evidence-based medicine” has led to rigid algorithms–cookbook recipes, really–for patient care. Experienced physicians know these algorithms are often a poor fit for patients with multiple medical problems, and must be ignored or subverted for the good of the patient.  At the same time, the physician may face criticism or sanctions for not following protocol.

2.  Bureaucrats and regulators seem convinced that if only we can produce enough care protocols, we can cut out physicians altogether and save money by having advanced practice nurses take care of everyone.  They encourage the devaluation of physician education and expertise. This seems to be the philosophy behind the proposed new VA rules which would eliminate physician supervision of veterans’ health care. (I’ll be curious to see if physician-free care will be considered good enough for the President and the Congress.)
And also:
Fee-for-service pay isn’t the chief culprit.  The best physicians stay busy because they have respect and referrals from their peers.  As they develop a base of satisfied patients and colleagues who recognize clinical excellence, they achieve financial success and have no wish to perform unnecessary procedures.  Price-fixing of physician services by third-party payers is the root cause of financial pressure to increase the number of services provided.
For more details on how our current problems and the right way to fix them, read the full text of, "His diagnosis is right, but the treatment is all wrong".