RESEARCH - Doctors' haste seen hurting patient

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Doctors' haste seen hurting patient

Study says the push for quick treatment detracts from care

By Kotulak

Tribune science reporter

Published May 10, 2005

Doctors are failing to provide Americans with the best care that modern

medicine has to offer, according to a national survey of physicians that

puts the blame on a revolving-door system of medicine in which doctors are

rewarded for sacrificing quality to see patients as fast as they can.

The findings are in line with the results of other studies suggesting that

as advances in medicine increase dramatically and drugs, surgical procedures

and other treatments become more effective, doctors are falling behind in

their ability to transfer the benefits to patients.

The study, carried out by the Commonwealth Fund, found that a majority of

doctors are not involved in improving the quality of their practices, are

reluctant to share information about the quality of care they provide with

the public, and have seen instances where quality of care was compromised.

" It is shocking that doctors don't know what the quality of their care is

compared to their peers, are very reluctant to make such information

available to their patients and the public, and are not continually engaged

in major efforts to improve care, " said the Commonwealth Fund's executive

vice president, Dr. Shoenbaum, co-author of the report.

The study, reported in Tuesday's issue of the journal Health Affairs, called

on physicians to support measures to improve quality, but other experts said

more action is needed, such as changing the payment system so doctors are

rewarded financially for providing better care.

Quality of care is measured through a broad range of factors, from blood

tests, access to patient records and drug prescriptions to keeping up with

the newest treatments and how often patients should be seen and followed up

with.

Several pilot projects have been launched in the U.S. to test the

feasibility of paying doctors more for providing more comprehensive care to

patients. In Britain the government will begin paying primary care doctors

up to 37 percent more per year for providing top-notch care.

The Commonwealth Fund study surveyed more than 1,800 physicians nationwide

and found that 58 percent said their income was based on their productivity

and half said they would lose money on providing quality care. Physicians in

solo practice or small groups were found to be more likely to neglect

quality-of-care measures than those in large groups or academic medical

centers.

" The variability of quality in the U.S. and the overall low level of quality

compared to what it could be, and the fact that not all that much is being

done to improve it, really is a national scandal that people are just not

aware of, " said Dr. Lawrence Casalino, assistant professor of health studies

at the University of Chicago.

Casalino found similar results in a study of 1,040 medical groups that he

and his colleagues reported in the Journal of the American Medical

Association in January 2003.

They looked at 16 quality-of-care measures for asthma, diabetes, congestive

heart failure and depression and found that on average the medical groups

provided less than a third of the recommended procedures.

The problem has less to do with unwillingness on the part of doctors to

improve care than with a system that pays doctors for seeing more patients,

Casalino said. " We have a fabulous medical technology and, for the most

part, very dedicated and well-educated doctors. The problem is with the

system. "

The Illinois State Medical Society and the American Medical Association are

concerned about problems with quality care and have worked with doctors to

improve their performance, said Dr. O'Toole, a cardiologist with

Midwest Heart Specialists in DuPage County who works with both organizations

on performance standards.

" We believe in the need for good quality care and some accountability in

that care, " he said. " The patients we care for have a right to know what's

good quality care, and at some level the people paying the bills should know

what's good quality care. "

The Commonwealth Fund study found that three-fourths of the physicians did

not use electronic medical records to keep track of their patients,

two-thirds were not involved in efforts to redesign systems to improve care,

and two-thirds did not have any feedback about the quality of their own

clinical performance.

One out of 10 doctors said they often or sometimes saw patients receiving

the wrong drug or wrong dose, one out of three said they often or sometimes

felt a patient's care was compromised, and one out of three said tests or

procedures had to be repeated because of errors.

" If the medical system were a bank, you wouldn't deposit your money here,

because there would be an error every one in two to one in three times you

made a transaction, " said Dr. Persell, who studies quality medicine

issues at Northwestern University's Feinberg School of Medicine.

Of the physicians surveyed, 69 percent said the public should not have

access to information on physician performance. But 55 percent said patients

should have that information on their physicians, and 71 percent said

physician performance data should be available to the leaders where they

work.

" Physicians want to perform high-quality care, but they have huge financial

and cultural barriers to changing their practice, " Persell said. " Without a

major external motivation, they're not going to be able to make big

improvements in health-care quality. "

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rkotulak@...

Copyright © 2005, Chicago Tribune

http://www.chicagotribune.com/features/lifestyle/health/chi-0505100152may10,1,31\

39969.story?coll=chi-news-hed

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] GINA--any research on this?

>

>

> One of the biggest problems I see in modern medicine is HASTE. Is

> anyone studying the ill effects of being too rushed to actively

> listen, too hyper to think clearly, and too careless to avoid simple

> mistakes?

>

> It's the biggest concern I have with my medical care.

>

> Sierra