How Measurement Fails Us

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You can have two of the three: Low cost, Efficiency, or Quality, but not ALL three!

This is a truism from the world of business management, one that applies to medicine as well as the business world—you can’t get it all. If you are looking for the “best” of anything, you need to choose two of the three qualities you most desire: Quality, Low Price, or Efficiency and Ease of use. The choices are the same in medicine as they are in business, but to fix the healthcare system, we must achieve all three…and I am not sure that that goal is a possible reality. Sadly when I am asked how I would change the medical care of the US into a workable system I give these answers.

  1. Change how you choose doctors.
  2. Change the trend to save money on doctors’ salary– either educate doctors for free or pay them at the highest pay scale of all professionals to recompense them for the years without wages and the outrageous cost of medical school and residency.
  3. Decrease record keeping to leave more time for face to face—and stop measuring physicians by tiny increments of record keeping data.
  4. Control costs of pharmaceuticals and give more to the experts that care for doctors and nurse practitioners.
  5. Stop pre-approval of doctor’s decisions on medications. This would save time and money for doctors, and insurance companies would save money on all the staff answering our pre-approval begging phone calls.
  6. For primary care, measure long term lack of illness, improved quality of life, and the number of people in a practice who do not end up with early death or nursing home living within a doctor’s practice. Measure against his or her first year of practice and the current one which keeps the cohort the same.

Choosing people to be Doctors and Nurse Practitioners: To have quality medicine you need well trained, smart affable people who are dedicated to treating their fellow human being with dignity, and love, with proposed outcome being a quality of life like one that the doctor would desire.

To get that type of doctor, you must choose women and men by their problem-solving capabilities as well as their ability to memorize the necessary facts, in addition to unending stamina available for long hours of work and denial of their own needs.

Once you have the right people, then you should train them, not to be arrogant and supercilious, but kind and humble caretakers who take joy from seeing their patients healthy!

Then you must remove the worry of debt, paying overhead in their office and the restrictions that hospitals place on them that deny them the ability to choose the correct and most efficient care for their patients. Restrictions of choice to doctors only makes patients angry and frustrated.

Lastly, you want doctors to be very well paid, becoming a doctor cost a lot, on top of the monetary investment that they must front in order just to become a doctor, physicians must, also train for a total of 7-12 years (depending on their specialty) at very low pay as a resident. If you do not recompense these people they will not continue to practice and your investment with them is gone!

Everyone is interested in finding out what works best in the practice of medicine. Data acquisition is a laudable goal. If we can crunch the numbers we can find out about what seems to work best for the largest number at the cheapest cost. That makes sense. But data acquisition is working like a rapidly growing cancer. Doctors are spending more and more of their time filling out forms and checking boxes on their EMR (electronic medical records) computers, this is a requirement that is taking time and attention away from interacting with the patient. The forms that are filled out are sent to people who use statistics and focus more and more on cost parameters instead of medical parameters. When data keeping focuses on cost management more than it does on medicine we get “managed” care and regulatory interference with doctors practicing the medicine they learned to practice.

We want and use information to find out the best interventions and the best practices for symptom reduction and health improvement. We do not want to lose that in an endless quest for bureaucratic efficiency and cost savings determined by accountants and politicians. Use data acquisition wisely to help health outcomes and not to control medical practices and make pharmaceutical and insurance companies wealthy!

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC.,
Family Counselor, Presenter and Author.

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