In a system of upside down incentives – a fee-for-service payment model that results in doctors doing too much – more tests, more procedures and more treatments, left almost entirely up to a doctors “informed intuition”.
Intuition indeed is necessary in medicine, explains Jerome Groopman, in How Doctors Think, but can lead doctors astray. Numbers on the other hand can help resolve quality variation by data-driven methods.
After years of knowing the benefits of beta-blocker prescriptions, safety checklists and so called ‘evidence based practices’, what keeps doctors from doing what they know? Can we afford to rely on the variability of their good judgment and intuition? Why are quality managing practices like lean and Six Sigma facing so much resistance in the practice of healthcare?
Quite simply put, because we trust our doctors to do what is best for us. Hospitals and physicians that provide less than top-quality care are rarely punished. There is that, and how we pay for healthcare. Volume care is compensated, irrespective of the added value for patients.
In the midst of the country’s struggle to health reform (or lack thereof),this article offers a refreshing look at what can be done right. Brendt James – the champion of the ‘Intermountain way’ challenges doctors to continuously test and tweak protocols, set clinical goals, track patient outcomes and deliver quality care at low costs – offers reason for optimism.
Thanks for the post, Divya! Can you direct us to the blog that you're writing for so that we can learn more about this topic?
ReplyDeleteI also read "How Doctors' Think" recently and highly recommend it. The recent New Yorker article about Brendt James that you mention is also a shorter, more concise summary of the ongoing tension between intuition vs evidence based medicine. I suppose the challenge is finding that ultimate "balance" between the two...being mindful of quality outcomes and current scientific research and guidelines, while still allowing physicians a degree of autonomy in their practices!
Here is the link to Costs of Care:
ReplyDeletehttp://www.costsofcare.org/ and the blog:
http://costsofcare.blogspot.com/
Costs of Care is a nonprofit 501(c)(3) social venture that helps doctors understand how the decisions they make impact what patients pay for care.
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Interestingly, in the NYTimes article, Jerome Groopman and Brendt James don't entirely agree with each other on the issue. Groopman seems still more pro doctor judgement where as James is pro data-driven guidelines. Either way, if more hospitals were to give research in practice more emphasis, doctors themselves could better understand the decisions they make.