DB'S MEDICAL RANTS

Internal medicine, American health care, and especially medical education

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HEDIS measures

Had an interesting dinner discussion recently with an internist and a pathologist.  They both had HEDIS stories.

The internist’s group is developing a medical home.  Part of the medical home is a reminder system to patients to come in for preventive medicine.  His 40-year-old female patient received a letter telling her she needed a mammogram.  Most readers know that this is controversial (she has no family history).  The physician was irate, because as he reads the literature mammography at that age does more harm than good.  So the system solution negatively impacted his autonomy at trying to evaluate the medical literature.

Anytime suits interfere with physician autonomy, physicians get angry.  Autonomy is a basic need for any worker.  Sometimes one must interfere with that autonomy, but in this case I believe the physician was correct.

Next the pathologist recounted a call from a suit who wanted the lab to provide a urine protein for every diabetic patient.  The pathologist asked, “What type of urine protein measurement”.  As he relates, did they want a dipstick protein or a urine protein/creatinine ratio or a microalbumin, etc.  The suit responded it does not matter, the HEDIS measure just says urine protein.

Suits want to meet HEDIS measures because their operations are judged by these numbers.

I urge the readers to write the rest of this rant.  I will say that these two examples show a danger of any measure, even one that is well considered.  Physicians are really capable of intelligent thought.  If you want nonthinking physicians, then you deserve them.

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