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Giving Doctors Grades Has Backfired
HughPickens.com writes: Beginning in the early 1990s a quality-improvement program began in New York State and has since spread to many other states where report cards were issued to improve cardiac surgery by tracking surgical outcomes, sharing the results with hospitals and the public, and when necessary, placing surgeons or surgical programs on probation. But Sandeep Jauhar writes in the NYT that the report cards have backfired. "They often penalized surgeons, like the senior surgeon at my hospital, who were aggressive about treating very sick patients and thus incurred higher mortality rates," says Jauhar. "When the statistics were publicized, some talented surgeons with higher-than-expected mortality statistics lost their operating privileges, while others, whose risk aversion had earned them lower-than-predicted rates, used the report cards to promote their services in advertisements."
Surveys of cardiac surgeons in The New England Journal of Medicine have confirmed that reports like the Consumer Guide to Coronary Artery Bypass Graft Surgery have limited credibility among cardiovascular specialists, little influence on referral recommendations and may introduce a barrier to care for severely ill patients. According to Jauhar, there is little evidence that the public — as opposed to state agencies and hospitals — pays much attention to surgical report cards anyway. A recent survey found that only 6 percent of patients used such information in making medical decisions. "Surgical report cards are a classic example of how a well-meaning program in medicine can have unintended consequences," concludes Jauhar. "It would appear that doctors, not patients, are the ones focused on doctors' grades — and their focus is distorted and blurry at best."
Surveys of cardiac surgeons in The New England Journal of Medicine have confirmed that reports like the Consumer Guide to Coronary Artery Bypass Graft Surgery have limited credibility among cardiovascular specialists, little influence on referral recommendations and may introduce a barrier to care for severely ill patients. According to Jauhar, there is little evidence that the public — as opposed to state agencies and hospitals — pays much attention to surgical report cards anyway. A recent survey found that only 6 percent of patients used such information in making medical decisions. "Surgical report cards are a classic example of how a well-meaning program in medicine can have unintended consequences," concludes Jauhar. "It would appear that doctors, not patients, are the ones focused on doctors' grades — and their focus is distorted and blurry at best."
How could no one have foreseen the potential abuse and pitfalls of a system like this? Without even reading any further than "Giving Doctors Grades..." I immediately conjured images of a bunch of doctors huddled around each other saying, "I don't want that one." "Well I don't want that one either. My feedback is back at 85% and I can't risk another death screwing me over."
It's actually much worse. Teachers who toil away in schools where the students get little or no parental or peer support for learning, get hurt very badly by these grades, because regardless of how hard they work on the students, they do less well on standardized tests (and improve less) than students who grow up in suburban environments that encourage learning.
So it becomes a terribly dis-incentive for the best teachers to go to the schools that need them the most - they'll grab all the plum assignments in the nice, rich, suburban schools, while fresh teachers get sent to the inner-city schools (perpetuating this situation).
competence isnt being measured here. the altruistic goals, "live" or "dead" instead are supplanting good science to determine which doctors are and are not performing well. Death is not objectively bad in cases where it is an unavoidable consequence of environment or genetics. Quality of care and quality of life, the two metrics doctors have always used, is a far better judge of performance. If a 78 year old chronic smoker dies from emphysema then it is of little use to chastise a surgical team or doctor for the death.
Good people go to bed earlier.
It's still a good idea, but the metrics need to be better thought-out to account for the patients that are being seen. A proper system will also "grade" each patient based on how bad their condition is, and then combine the mortality rates to come up with a metric that reflects how well the doctor is doing at improving outcomes where it is possible to do so.
I think there's a ton of money being dumped into the walking dead.
When my mom was at stage 4 of metastasized breast cancer, we had a family meeting with the oncologist to discuss my mom's situation. When asked what -- if any -- chances she had for life extension (not a cure, but more than 12 months) he was totally equivocal about it and was basically looking to start another round of chemotherapy. I felt like he was just looking for another round of payments before she died. They give you the thinnest hope to try to get you to keep using their services.
I've heard similar stories before from other people with older relatives, very sick and unlikely to every recover in any meaningful sense of the word yet the doctors insist on expensive and invasive treatments. The only explanation I can think of is that it's good business for them.
Maybe some of the administrators whose job it actually is to evaluate their teachers should have their feet held to the fire. The city I live in, every principal in every school must spend two hours a year in each teacher's classroom evaluating their teaching methods and performance.
Two. Hours. A year.
Since they won't do their jobs, they're falling back on ridiculous metrics to do it for them. They get paid 2-3x as much as the teachers they're supposed to be evaluating too. Seems that all of these new programs are meant to support the administrative jobs much more than the learning the students receives.