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How Do You Measure a Good Doctor Vs a Bad One?

Quantifying a physician's performance is like trying to catch a cloud with a butterfly net.

by
Theodore Dalrymple

Bio

November 26, 2013 - 9:00 am
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Some of the residents of Hyde, the town in Cheshire, England, where the late Dr. Harold Shipman practiced family medicine, used to say, “He’s a good doctor, but you don’t live long.” Indeed not: it is now believed that Dr. Shipman, over a period lasting a quarter of a century, murdered 200 or more of his elderly patients with injections of morphine or heroin.

If the preservation of life be not the definition of a good doctor, what is? Here is the definition published in a recent edition of the New England Journal of Medicine:

The habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and, the community being served.

Whatever one thinks of this definition, it is clear that it would not make the goodness of doctors altogether easy to measure.

It does not follow from the unmeasurability of something, however, that it does not exist or is unimportant: nor, unfortunately, that what is measurable truly exists or is at all important. Nothing is easier to measure in an activity as complex as medical practice as the trivial, and nothing is easier to miss than the important.

The above definition of a good doctor appeared in an article on the need for Obamacare to ensure that doctors provide value for money so that they can be paid by result. This is a potential problem whenever there is a financial intermediary between the doctor and the patient. Thenceforth it is not the patient who decides what he wants from a doctor but an insurance company or, increasingly under Obamacare, the government.

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Top Rated Comments   
"The habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and, the community being served."

I am going to re-write that the way it is read by Progressives:

Blah blah blah blah blah blah blah - for the benefit of - blah blah blah - the community being served.

When the "community" is paying for your health care, then you the individual are subordinated to the the needs and wants of the government of that community. Be afraid. Be very afraid.

47 weeks ago
47 weeks ago Link To Comment
I don't think in the fantasy world of Obamacare it will matter for the following reason. I recently was a minor witness at a medical malpractice civil trial in Virginia where a young woman had an ischemic stroke that came on suddenly with classic symptoms including disorientation, slurred speech, left side paralysis, vertigo, power vomiting and inability to stand or walk but was fortunately taken to the ER within 10 minutes of the stroke. The ER doctor received her history from family then saw her for 30 seconds, did no neuro exam but ordered a CAT scan and discharged her to her family who had to literally carry her out of the hospital in a near comatose state. Discharged with no improvement and without seeing her again beyond that first brief observation. The young woman was a perfect candidate for TPA which if given within 3 to 4.5 hours would've prevented permanent brain damage. She was young, athletic, healthy and very fit. The young woman was properly treated the next morning when her primary care doctor saw her and ambulanced her to another hospital but by then the damage was permanent and massive. She spent three weeks in ICU while teams of good doctors worked round the clock to save her life. She spent two months in a rehab hospital where they worked on getting her to do just the most basic things to get her to function although she is disabled and unemployable for life. The trial was preordained from the jury selection. All of the jury pool said they were biased toward the doctor during jury selection. All of them to my astonishment said even if the doctor made mistakes, even fatal ones, their years of training and status in society merited exempting them from liability for their actions. Then during the trial the doctor was asked how she would diagnose and deal with a stroke and she admitted she did not know. She further admitted that the hospital had a standard of care, a protocol, to follow in potential stroke cases but she did not know what it was. Yet even this level of incompetence did not sway the jury who quickly found the doctor not guilty. I sadly surmise that between Obamacare and this level of apathy on the part of the public, bad doctors will become the norm not the exception. No wonder Obama thinks nurses or PAs can see patients in lieu of doctors. His idea of doctors is the doctor whose gross negligence destroyed this young woman's life. Compared to this doctor, nurses and PAs would be an improvement.
47 weeks ago
47 weeks ago Link To Comment
I was in the trade for 20 years. My experience was that competent doctors and brilliant doctors had pretty much the same outcomes. Certainly incompetent or malicious health care providers need to be identified and removed; alas, that's kind of a tombstone job because that's how we find the incompetent and the malicious.
In my experience, a courteous and compassionate provider who was also competent was preferable to a brilliant jerk. The difference between brilliant and competent didn't change outcomes much but the different personalities changed the experience quite a lot.
47 weeks ago
47 weeks ago Link To Comment
All Comments   (12)
All Comments   (12)
Sort: Newest Oldest Top Rated
These giant bugs are terrifying . . . But I can't look away. http://bit.ly/1jRUnuR
46 weeks ago
46 weeks ago Link To Comment
Good Dr.:
One that recognizes and explains that medicine is an ART that utilizes science but is not itself a science.
47 weeks ago
47 weeks ago Link To Comment
v
47 weeks ago
47 weeks ago Link To Comment
Success in solving the problem often begins with listening to the patient and asking them the right follow up questions.

I've known a physician or two with wonderful technical skills who didn't take time to listen. I've also known hacks who jump to conclusions based upon superficial appearances or who try to fit symptoms into the diagnosis du jour. (a particular problem I suspect among shrinks.) Then there was the physician who instead of listening to concerns about a course of treatment she proposed decided I was having an emotional problem accepting the diagnosis and wanted to add an anti-anxiety drug to the already large pharmaceutical cocktail she was prescribing. I call that malpractice per se. A second opinion eliminated several of the drugs and I felt better at once.
47 weeks ago
47 weeks ago Link To Comment
The first criteria would be success in solving a problem. The second would be honesty in what the problem is, why you can't solve it and pointing to places where it can be solved or where you can at least get an honest informed second opinion.

Actually, a doctor who sincerely follows the Hippocratic Oath is probably going to be a pretty decent doctor.
47 weeks ago
47 weeks ago Link To Comment
Hippocrates + Marketplace = Good Doctor

Tort reform would help.
The tip off with Shipman was '...but you don’t live long'.
The judgement of the effing gov't and insurance co. has no useful role.
Not too sure about the bureaucratic minds at the New England Journal of Medicine, either.
47 weeks ago
47 weeks ago Link To Comment
"The habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and, the community being served."

I am going to re-write that the way it is read by Progressives:

Blah blah blah blah blah blah blah - for the benefit of - blah blah blah - the community being served.

When the "community" is paying for your health care, then you the individual are subordinated to the the needs and wants of the government of that community. Be afraid. Be very afraid.

47 weeks ago
47 weeks ago Link To Comment
The idea that a doctor has a responsibility to the community as well as his patient destroys the doctor-patient relationship. "Social justice" must be served even if it is at the expense of the individual patient, as it often is. See Richard Fogoros website covertrationingblog.com and read his book "Open Wide and Say Moo" for an excellently thought out criticism of what Obamacare will do to American medicine.
47 weeks ago
47 weeks ago Link To Comment
I don't think in the fantasy world of Obamacare it will matter for the following reason. I recently was a minor witness at a medical malpractice civil trial in Virginia where a young woman had an ischemic stroke that came on suddenly with classic symptoms including disorientation, slurred speech, left side paralysis, vertigo, power vomiting and inability to stand or walk but was fortunately taken to the ER within 10 minutes of the stroke. The ER doctor received her history from family then saw her for 30 seconds, did no neuro exam but ordered a CAT scan and discharged her to her family who had to literally carry her out of the hospital in a near comatose state. Discharged with no improvement and without seeing her again beyond that first brief observation. The young woman was a perfect candidate for TPA which if given within 3 to 4.5 hours would've prevented permanent brain damage. She was young, athletic, healthy and very fit. The young woman was properly treated the next morning when her primary care doctor saw her and ambulanced her to another hospital but by then the damage was permanent and massive. She spent three weeks in ICU while teams of good doctors worked round the clock to save her life. She spent two months in a rehab hospital where they worked on getting her to do just the most basic things to get her to function although she is disabled and unemployable for life. The trial was preordained from the jury selection. All of the jury pool said they were biased toward the doctor during jury selection. All of them to my astonishment said even if the doctor made mistakes, even fatal ones, their years of training and status in society merited exempting them from liability for their actions. Then during the trial the doctor was asked how she would diagnose and deal with a stroke and she admitted she did not know. She further admitted that the hospital had a standard of care, a protocol, to follow in potential stroke cases but she did not know what it was. Yet even this level of incompetence did not sway the jury who quickly found the doctor not guilty. I sadly surmise that between Obamacare and this level of apathy on the part of the public, bad doctors will become the norm not the exception. No wonder Obama thinks nurses or PAs can see patients in lieu of doctors. His idea of doctors is the doctor whose gross negligence destroyed this young woman's life. Compared to this doctor, nurses and PAs would be an improvement.
47 weeks ago
47 weeks ago Link To Comment
I was in the trade for 20 years. My experience was that competent doctors and brilliant doctors had pretty much the same outcomes. Certainly incompetent or malicious health care providers need to be identified and removed; alas, that's kind of a tombstone job because that's how we find the incompetent and the malicious.
In my experience, a courteous and compassionate provider who was also competent was preferable to a brilliant jerk. The difference between brilliant and competent didn't change outcomes much but the different personalities changed the experience quite a lot.
47 weeks ago
47 weeks ago Link To Comment
"The perfect is the enemy of the good."
47 weeks ago
47 weeks ago Link To Comment
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