by Richard Reece, MD
How do you judge how good a doctor is? By personal interaction? By what relatives and friends say? By whether he or she is on time when you go for your visit? By doctor rating websites on the Internet? By patient satisfaction surveys conducted by doctors themselves or rating agencies?
Or do you do it by the numbers? The federal government and health plans are increasingly issuing periodic â€œreport cardsâ€ containing â€œobjectiveâ€ evidence of how well doctors are doing in achieving â€œqualityâ€ goals.
How can one argue with this approach, which may become the basis for â€œpay for performanceâ€ programs? After all, if you canâ€™t measure something how can you judge it? This is the cornerstone of management â€œscience.â€
The answer, according to Danielle Ofri, MD, PhD in the New England Journal of Medicine,, is that these numbers and these reports are often meaningless to individual physicians.
Here is how she, an internist at New York University School of Medicine and Bellevue Hospital explains her reaction.
â€œThe quarterly â€˜report cardâ€™ sits on my desk. Only 33% of my patients with diabetes have glycosylated hemoglobin levels that are at goal. Only 44% have cholesterol levels at goal. A measly 26% have blood pressures at goal. All my goals are well below my institutionâ€™s targets.â€
â€œItâ€™s hard not to feel like a failure when the numbers are so abysmal. Weâ€™ve been getting these reports for 2 years now, and my numbers never budge. Itâ€™s wholly dispiriting.â€
She is beginning to wonder if these numbers really mean anything. Are they a valid measure of physician competence? How would patients react to them? Should the numbers be used to judge and compensate doctors?
One thing she does know. â€œThese statistics cannot possibly capture the totality of what it means to take good care of patients. They merely measure what is easy to measure.â€
So what does she do with the numbers?