Diane\'s Blog

Pacific Northwest Physician

Dear Dr. Ravitch,

I am a family practice physician in the Pacific Northwest. A few weeks ago I was driving home from the annual meeting of the Independent Physicians Association and I heard a rebroadcast of your interview on Oregon Public Broadcasting. The meeting was nothing more than a big “Rah-Rah!” session for healthcare reform which is a topic that makes a lot of us uneasy, and as I listened to your interview I found myself thinking, “My God, this is exactly what we are doing to healthcare…” The things that made educational reform a disaster are exactly what makes me uneasy about healthcare reform.

The electronic medical record is indeed a great way of keeping records but it does not necessarily improve quality. It has its own pitfalls and as one of my older patients aptly stated, “When things get automated people stop thinking.” The real move with the electronic record is toward using the data to assess standardized “quality measures” and to then enact pay-for-performance. This is not unlike the standardized testing used to assess the performance of schools.

The other parallel I saw was between charter schools and “accountable care organizations.” As more and more clinics strive to achieve this designation, we may see them trying to exclude patients or populations who tend to make their numbers look bad. These also tend to be the patients who need the most help.

I fear we are moving toward treating numbers and not people. In my own experience the real quality happens in the relationship between the doctor and the patient, and pay for performance comes about as you build trust with your patients and they come back to you. Accountability has to be shared by the individual patient (we can’t go on treating people who knowingly abuse their health).

I was wondering if you have any thoughts on this, or if you have any interest in the issue. If you know of anybody who shares this interest, please put me in touch.

(Name Withheld)