Doctoring Health Care Health Care Reform

Measuring quality of medical care. How can a consumer know?

While typing words, the advertisement for yet another hospital is overheard from the TV.  “Ignore it John,” I think to myself, but, it is impossible to not look up and see.  The head shakes with a smirk, like my grandfather did and without words displeasure was easily conveyed.

Do people really think the graphical professionalism of a TV spot is even remotely an accurate metric of quality of medical care?

At work, a group of hospital nurses who live adjacent to the “rural” surrounding counties unequivocally informed me ads do matter to many.

“Come on, people believe a TV ad?” I ask.  “Absolutely, yes,” the answer.

Measuring quality of medical care, so consumers can be informed, is a hot topic these days.  Metrics to measure are abundant and pre-determined, and so compliance with specific therapies on a few disease states act as a surrogate for an entire institution’s quality.  This is like judging how republican a person is by their shoes alone.

Indeed, there are many much better markers for truly good quality of care.  For example, a rarely mentioned, but far more indicative measure of a hospital’s quality of care is the vigor of the peer review system.   In other words, how much surveillance of medical practice is present?

Do patients even know that hospitals have these committees and that they vary widely in the degree of scrutiny?

Each November the call comes from the Medical Staff office in which the question of serving on a medicine peer review committee is broached.  Always, I answer in the affirmative.  Once a month, very early in the morning there is a meeting of respected peers in which interesting cases are discussed, like morning reports or morbidity and mortality conferences were in residency training.  A physician advisor screens cases and if there are questions on quality, the issues are discussed amongst a diverse group of generalists and specialists.  Outliers fall out and garner attention.  Level headed doctors from competing groups are chosen and the fairness is palpable.

To hear other highly respected doctors in disparate areas comment on difficult cases is immensely gratifying.   Medicine is special that way, as even the seemingly mundane case serves as a scaffold for commentary on important matters of debate, and thus, education happens.

Although the life of an electrophysiologist is spent primarily in a lead walled EP lab, one of the many aspects of medical life for which I am most grateful, is the interaction with outstanding colleagues.  Serving with them in the review of clinical medicine surely advances the quality of care in our hospital, albeit in an unreportable manner.

Many things make us better doctors, but it is clear, at least to me, the review of challenging cases with motivated colleagues of diverse expertise has to rank higher than mindlessly documenting pre-determined obviousness so as to improve our internet scorecard.


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