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Editor's Column:
Asking Editors To Take Better Care
By JOSEPH WEISS, MD
In
an editorial titled PAYING DOCTORS FOR BETTER CARE (New York
Times, Dec. 26, 2006), the New York Times editorial staff comes
out in favor of vigorous congressional action to strengthen
pay-for-performance features of Medicare.
The editorial
is worth a physician’s read as it represents what the public is
hearing on the assumption, assertions, and expectations of those in
on the pay-for-performance crusade. The editorial shows physicians
the attitudes we must challenge if we are to avoid another paper
scuffle similar to what we face with HIPAA and its privacy
regulations.
The editorial
begins with the assertion that: “a doctor who botches a surgical
procedure, diagnostic test, or drug prescription, profits from his
mistake. He gets paid for the botch up and then again for mitigating
the mistake.”
First,
physicians err, not “botch up.” Second, the editorial ignores and
makes no mention of the concern, pain, grief and even humiliation
our errors cause us. The editorial pretends blindness to the notion
that not only are there things in life that money cannot buy, but
instances occur to us for which reimbursement will not compensate.
The editorial
next assumes that the data Congress collects will identify doctors
who practice the best medicine. Not noted is that the quality
measures of the moment represent what is easiest to ascertain.
Whether such information reflects quality or desired outcomes
remains unknown.
The editorial
goes on to state that pay-for-performance has received support
throughout the medical community. Missing is the observation that
much of that support represents our leaders responding to a trend
they believe that it is better to go with than oppose.
The editorial
concludes with the assertion that medical errors: “harm tens of
thousands of patients and drive up costs substantially.” In fact, no
one knows if the US rate of medical error is “alarming,” as no other
country has published its statistics.
The remark
that error drives up the cost of medical care substantially also
requires a rebuttal. The editors should consider how great the
expense required to keep the elderly ill of this country alive and
functioning. Furthermore, the editorial ignores the cost associated
with technology and greater medical understanding that allows us to
intervene today, when previously all we held out to patients was
hospice care.
The Times
editorial repeats and asserts what its editors hear. It falls to us
to challenge their commentary and change it to consider the goals of
health care in this country and how to reach them.
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