Are physicians responsible for reducing costs?

According to a recent paper in JAMA [JAMA. 2013;310(4):380-388. doi:10.1001/jama.2013.8278], the answer seems to be no. The authors surveyed (randomly) physicians from the AMA masterfile. They had a decent response rate (56%) and sample size (n = 2556). Only 36% reported that practicing physicians have a responsibility to reduce costs. The authors argue that the picture is complex and that this raw statistic hides the devil in detail. For example, 78% reported that (78%) and that “doctors need to take a more prominent role in limiting use of unnecessary tests”. Looking at the data from an organizational perspective, I wonder whether the data reveal something important about the way that doctors feel that they do not belong to their organisations. Thus, the data might be a symptom of a more serious malady. The feeling that one does not fully belong to an organisation is unlikely to be fixed by changing payment plans.

Working conditions for Irish and UK doctors

The following is an article from an Irish online journal. It represents the views of an Irish doctor with regard to the general working conditions for non-consultant doctors. It’s obviously written with a certain political angle, but it does provide interesting food for thought with regard to the European Working time directive.

http://www.thejournal.ie/readme/column-a-campaign-of-misinformation-has-turned-the-public-against-doctors-969649-Jul2013/

It’s interesting to contrast the previous link with a blog entry on the BMJ about the ethics of taking time off when sick. The author alerts us to the inherent contradictions  around professionalism. Again the European Working Time Directive is involved.

http://blogs.bmj.com/bmj/2013/07/08/julian-sheather-do-younger-doctors-take-more-time-off-sick/

Well being and Performance

The first international meeting on "Doctors think. Doctors feel. Doctors do: Well-being and performance in medical practice" (WELL-Med) will take place in 2014. The meeting will explore how physician burnout and wellbeing are related to different aspects of medical performance in terms of clinical decision making, communication in clinical practice, and medical error. 

The WELL-Med conference will take place between May 28th - June 1st in Alexandroupolis, in the unexplored North Coast of Greece.

During the conference we will be informed about “new evidence”, engage in some “blue sky thinking”, learn from our mistakes in the “research gone wrong” section and  identify successful interventions in the "what works" section.  We will also link theory to practice in the "medical stories" section, especially addressing health professionals, and healthcare managers working outside academia.  Finally doctoral students will have the opportunity to receive expert feedback in the "research in progress" section.

Keynote speakers

·         Charles  A. Vincent, Professor of Clinical Safety Research, Imperial College London, UK

·         Christina Maslach, Professor of Psychology, University of California, Berkeley, USA

·         Eileen Gambrill, Professor of Social Welfare, University of California, Berkeley, USA

·         Jean Wallace, Professor of Sociology, University of Calgary, Canada

·         Deborah Kirklin, Editor of the BMJ journal Medical Humanities, UCL, UK

·         Jane Lemaire, MD, Vice-Chair of Physician Wellness and Vitality, University of Calgary, Canada

·         Liselotte N. Dyrbye, MD, Associate Professor of Medicine, Mayo Clinic, USA

·         Hardeep Singh, MD, Chief  of  Health Policy and Quality Program, Houston VA Health Services, USA

                                                                       

The deadline for abstract submission is October 15th. Please visit our website,  http://wellmed.gr  for abstract submission guidelines.

Diagnostic errors more common, costly and harmful than treatment mistakes

This is the headline for an important review paper in BMJ in Quality and Safety. The paper is a must read for everyone. As noted by the authors, diagnostic errors are more complex and open up a huge can worms relative to surgical and medication errors. Given that the review only looks at the worst cases, the extent of the problem is probably severely underestimated. The results are even more striking when we consider the increase in defensive medicine. Psychology, in collaboration with medicine, has a huge role to play here.

The full paper can be found at: BMJ Qual Saf doi:10.1136/bmjqs-2012-001550

A short synopsis of the main results can be found at: http://m.hopkinsmedicine.org/news/media/releases/diagnostic_errors_more_common_costly_and_harmful_than_treatment_mistakes

Can we measure physician performance?

Can we measure individual physician performance? Social scientists have known for quite some time that performance evaluation can actually depress motivation. SO the question can actually become, not can we, but should we?  Cassell and Jain, in an interesting JAMA viewpoint paper [JAMA, June 27, 2012—Vol 307, No. 24] tackle the issue directly and present many compelling arguments as to why individual performance systems are likely to decrease intrinsic motivation and increase extrinsic motivation. The authors argue for more meaningful patient-centered goals that are clearly communicated. Ultimately, the authors recommend for more group/team based incentives. In my opinion, they are talking sense, and the paper is worth a read. Their paper is an interesting counter point to the idea of physicians as homo-economicus.  

Are GPs buckling under time pressure?

The need for physicians to see more people in less time is a stressor. The reduction in resources in healthcare means that such trends are set to continue and probably worsen. In a recent paper in BMJ Open (of which I’m a co-author) using an experimental approach, we found that under time pressure, adherence to guidelines concerning history taking and advice giving is compromised [BMJ Open 2013;3:e002700. doi:10.1136/bmjopen-2013-002700]. The research also found that GPs were less compliant with guidelines on giving advice on lifestyle, especially, concerning smoking habits. We should be mindful of how efficiency and effectiveness can travel in opposite directions. 

Are GPs buckling under time pressure?

The need for physicians to see more people in less time is a stressor. The reduction in resources in healthcare means that such trends are set to continue and probably worsen. In a recent paper in BMJ Open (of which I’m a co-author) using an experimental approach, we found that under time pressure, adherence to guidelines concerning history taking and advice giving is compromised [BMJ Open 2013;3:e002700. doi:10.1136/bmjopen-2013-002700]. The research also found that GPs were less compliant with guidelines on giving advice on lifestyle, especially, concerning smoking habits. We should be mindful of how efficiency and effectiveness can travel in opposite directions.