HOW GOOD IS YOUR DOCTOR?

Do you think you know how good your physician is? Unfortunately you don’t, and no one else really knows for sure, either.

It’s hard to believe but no physician can honestly tell you, themselves or anyone else whether they are excellent, good or merely mediocre at what they do. Why? Because American physicians have no objective performance measurements to assess their clinical competency.

The United States has a patchwork system for protecting the public from poor quality healthcare that is largely uncoordinated and ineffective and the medical community has consistently fought any attempt at objective performance measurement.¹

Rather, professional medicine uses highly subjective methods such as peer opinion, referral rates or self-evaluation of anecdotal incidents to determine “how good” a physician really is at his or her profession. All of these methods, of course, lack the unbiased truthfulness of measured data. Unfortunately, the only valid and reliable data most physicians received are their monthly financial billing summaries.²

Most physicians assume, however, that they practice high-quality, consistent medicine using the standards and guidelines that they were taught during their schooling and residency. This assumption implies that there is no compelling reason to measure care that is presumed to be excellent.³ Physicians in our healthcare industry continue to follow this assumption, even without objective measurement information to support their assumptions. It is time for physicians to assume accountability for the objective measurement of their own performance.

Whenever physician performance measurement has been undertaken in this country, however, the results are shocking. “Mediocre” is sometimes the best word one can use to describe what’s revealed:

• According to a recent Rand study, even patients with the best available insurance received the appropriate, recommended care from their physicians only 55 percent of the time!⁴
• In a study of beta-blocker administration, our nation’s cardiologists prescribed the lifesaving medication for only 52 percent of eligible heart attack patients.⁵
• A 2004 study found that physicians in teaching hospitals washed their hands appropriately only 57% of the time.⁶

The list can go on and on. Sadly, these performance results reflect the standard of care practiced in American medicine today. Our healthcare system has ignored quality measurement long enough; our physicians have ignored the measurement issue long enough.

Our health system must assume accountability for the objective measurement of its physicians performance. Relying on anecdotal information or “gut feeling” is not enough anymore. The old standard of accountability is too subjective and inaccurate to meet the demands of today’s patient safety and quality environment.⁷

Doctors have long enjoyed autonomy in their practices, but the price for that autonomy should be accountability.⁸ In short, it’s just not possible to be accountable without performance measurement.

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Last update on: 10/2/06

1. Millenson ML. Miracle and Wonder: The AMA Embraces Quality Measurement. Health Affairs May/June 1997 Vol:16:183.
2. Newcomer LN. Physicians, Measure Thyself. Health Affairs. July/August 1998 Vol.17:32.
3. Ibid.
4. Kerr EA, McGlynn EA, Adams J, Keesey J, and Asch SM. Profiling the Quality of Care in Communities:
   Results from the Community Quality Index Study. Health Affairs May/June 2004 Vol. 23:247. See also, McGlynn EA, Asch SM, Adams J, Keesey J, Hicks, J, DeCristofaro A, and Kerr EA. The Quality of Health Care Delivered to Adults in the United States. New England Journal of Medicine. June 26, 2003 Vol. 348: 2635.
5. J. Jollis et al. Outcome of Acute Myocardial Infarction According to the Specialty of the Admitting Physician. New England Journal of Medicine. December 19, 1996 No. 25:1880.
6. Pittet D, Simon A, Hugonnet S, Pessoa-Silva C.L., Sauvan V and Perneger T.V. Hand Hygiene among Physicians: Performance, Beliefs, and Perceptions. Annals of Internal Medicine. July 6, 2004 Vol.141:1.
7. Newcomer LN. Physicians, Measure Thyself. Health Affairs. July/August 1998 Vol.17:32.
8. Ibid.