September 02, 2011
There's an interesting blog entry where Dr. Liu comments on Dr. Ofri's lament of being measured solely on clinical outcomes and not on interpersonal skills. Dr. Liu uses his own practice as a positive data point that it is indeed possible to have great clinical outcomes and great patient satisfaction.
What's interesting to me is that health care institutions sit on mounds of performance data (both clinical outcomes and patient satisfaction scores), but essentially none of that information is made available to patients when they select a doctor. You can argue about the meaningfulness of such outcome data, but the fact that health care institutions themselves measure their doctors' performance suggest that at the very least, the institutions believe there is some merit to the measures. If so, why not release it to the patients so they can factor it into their decisions regarding whom to visit for care? I suspect that responses would likely fall into one of the following camps:
1) "Patients won't know how to interpret the data or won't care" -- this might be true, but I think it's a tremendous stretch to say that all patients will be unable to interpret the data or won't care. Why not release the data so that patients who do care can make better decisions?
2) "We monitor our physician performance internally and ensure that all physicians are up to our standards" -- in other words, "don't worry, we've got you covered." Like the first response, this response is awash with paternalism. The institution assumes that its standards are at least as high as the patients' standards. Additionally, since there are multiple dimensions, not releasing the data deprives patients of the opportunity to select a doctor according to his own preferences. For example, one patient might be willing to put up with lower clinical quality indicators in favor of better patient satisfaction scores; or the reverse might be true. Either way, patients don't get the opportunity to choose for themselves.
3) "This is an issue of doctor privacy" -- this is probably the strongest response, and the argument is that doctor privacy trumps patient interest in his own health. Maybe. It's a little like a politician saying "there's no need to looking at my voting record -- I've got your interests covered." I'd bet that if the economics change such that disclosing performance numbers brings in significantly more revenue, health care institutions will suddenly find a new love for transparency, claiming it as a cherished virtue all along.
Who will be on the patient's side?