Assessing Doctor’s Performances

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In an article in the NY Times of Jan 12, 2013 a report was made that NY City hospitals will assess doctors performances  to the quality of care delivered. The evaluation will be based on number of tests (services) ordered as well as how well doctors communicate with patients, readmission of patients with pneumonia and heart failure,speed of emergency patients admitted to beds, doctors arriving on time for surgery, how quickly patients are discharged, how clean hospital floors are, attentiveness of nursing staff and availability of beds.

One can easily understand how several of these “indicators” are under multifactorial events not under the control of any one hospital or physician. I would like to address the more serious issues that are eroding the public confidence in medicine. On a one -on -one basis people appreciate their doctor but taken as  an entity by the media doctors are viewed less kindly.

There is no traditional model in medicine where a physician is rewarded for the “services” ordered. I am a plastic and reconstructive surgeon in private practice inCt. and RI for 28 years and I have never known or seen a colleague benefit from the article’s so-called “traditional model” of  rewarding for services ordered. First, our service is our personal hands on care of the patient. The “service” mentioned in the article really refers to tests ordered. Most tests are appropriate and some admittedly less so, but are ordered to “cover all bases” in case of litigation. This will not change until we have reasonable tort reform which would provide significant cost savings. There are a few errant practitioners but fewer in number than in any other profession. Our results are always visible, but the outcome is based on many complex factors than, for example, the number of re-admissions for pneumonia and heart failure. End-stage disease may not have improvement and home activity such as salt intake is not under direct physician control. We are professionals working with multifactorial health issues that are not possible to compartmentalize. We do not game the system and we deserve respect.