Doctors and patients divided about new guidelines

There was considerable confusion last fall when the United States Preventative Services Task Force changed its recommendations regarding mammogram screenings for women age 40-49. Several months later, a report in the Annals of Internal Medicine, as reported by The New York Times, says that there is a divide between physicians and patients regarding following those recommendations. Physicians are more likely to follow the guidelines, which recommend women start routine screening at age 50 and be screened every other year, while patients are more likely to want more frequent screenings as previously recommended.

The disparity points to the continued communication challenge, as physicians and patients must clearly convey their desires and reasoning for screening procedures.

Rating your physician

The group that made restaurant, hotel and spa ratings by the public, available to the public, are now working with one health insurance group to rate physicians. The New York Times had an article today about WellPoint working with Zagat to allow patients to rate their physicians and read ratings of other physicians. Physicians are rated on such qualities as trust and communication. Some physicians and ethics groups are concerned that the ratings don't give patients useful information, and may ultimately cause harm to patients making decisions based on personality factors that have no correlations to patient outcomes. You can find the article here.

What do you think? Is this kind of rating system harmful? Is it possible for some kind of rating system to provide useful, accessible information?

Electronic health records

The New York Times technology section reported on some recent surveys about physicians and utilization of electronic medical records. Electronic medical records can be a great mechanism for improving quality-of-care and ultimately cost of care. Some especially useful features include warnings about drug interactions and reminder pop-ups for tests that should be done for a patient based on age and recorded conditions. The physicians who use such records are largely enthusiastic about them. But many doctors are still not using them, largely doctors in small and private practices. There are a number of reasons: the available software is largely geared toward, the initial start-up costs are very high, and the people who have to bear the costs, doctors, do not always see the cost savings, as in money saved from not having to repeat lost labs. Electronic records are something physicians want in order to be able to practice more efficient medicine, but the cost seems so incredibly daunting.

The answer may come, in part, in the form of government financial subsidies to help clinics transition to electronic medical records. Because if such systems improve quality and cost of care, everyone benefits.

You can find the NYT article here: http://www.nytimes.com/2008/06/19/technology/19patient.html?ex=1371528000&en=bc2c007f1a9df2b0&ei=5124&partner=permalink&exprod=permalink

How doctors see themselves

We started enrolling physicians into our study of quality communication last month. So I now spend a lot of time on the phone talking to physicians on the phone, trying to get them to rehearse with me how they will talk to their patients about a screening result. We will later analyze the taped rehearsals for quality of communication.

Physicians are busy, so we knew going in that recruitment would be difficult. But I can't help but speculate about who decides to practice and who does not. I know some people who decline to practice are simply too busy. But I can't help but think that some of those physicians who decline to practice don't think they need to practice. They think they are effective communicators already. And let's face it, most of them likely are not as good as they think they are.

And I wonder about those who decide to practice. Are they acknowledging that maybe they need to improve their communication skills? Or are they just being polite to the very polite screening lab follow-up worker who just happened to catch them on the phone?

It makes me wonder: How do these physicians see themselves and does it affect whether physicians will try to improve their skills?

Status careers

This article doesn't really have to do with doctors and communication, but it still caught my eye. The New York Times ran an article about how the traditional status careers - doctors and lawyers - are no longer considered the highest status careers. There has been a cultural shift in defining career success, one that focuses more on creativity and flexibility. Doctors and lawyers are important, staid careers, but they lack creativity, and are certainly not flexible as both careers demand long hours.

You can find the article here: http://www.nytimes.com/2008/01/06/fashion/06professions.html?ex=1357275600&en=e6188de13887a970&ei=5124&partner=permalink&exprod=permalink.

Medicine and law both have high burnout rates and growing levels of professional dissatisfaction. Though there are plenty of reasons for both, I propose that if you are going to go into these careers for the right reason. If you are going to these careers for status, you will not be satisfied. But if you go into these careers because they are what you love, that passion can sustain you through the most demanding days.

doctors and professionalism

The New York Times Health blog posted an article about a recent Annals of Internal Medicine survey about doctors and professionalism http://well.blogs.nytimes.com/2007/12/03/how-professional-is-your-doctor/.

Especially concerning is the number of physicians who are aware of and do not report medical errors. But there is a larger, systematic issue at play here. We cannot expect physicians to report medical errors when the system is stacked against them. There is a huge professional liability to reporting errors, whether your own or a colleague's. And while we can hope that a physician's ethical beliefs would cause him or her to rise above this, we cannot depend on it. I'm not saying that there are no situations in which the doctor should be held liable. But health systems have to work on a way that encourages doctors to report risks and errors without a constant fear of legal implications.

Grumpy old docs not quite as grumpy

That was the headline of a recent Wall Street Journal Health blog entry http://blogs.wsj.com/health/2007/10/26/grumpy-old-docs-not-quite-as-grumpy/. A survey asked doctors age 50-65 if practicing medicine was more or less satisfying than 5 years ago. In 2004, 74% of doctors said yes, practicing medicine is less satisfying than 5 years ago. In 2007, 52% answered yes. And while the title said grumpy old docs are less grump, the responses to the post leaned more towards grumpy than not. Make no mistake, medicine is a difficult, demanding profession. You have to be dedicated to spend that much time in school and training, and go into immense debt, to work in a system with less autonomy and falling reimbursements.

In all things, you have to love what you do. And physicians have to love what they do if they are going to make any effort to do it better.