Robert Centor comments on the UK’s P4P experience:
I maintain that for any generalist, our jobs remain so complex that report cards must emphasize only a small part of our job. As the Scottish physician so aptly puts, focusing on 15% of our patients probably detracts from the diagnostic energy and quality addressed for the other 85% of our patients.
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{ 1 comment }
I think P4P is inevitable. But if you stop to think about, it is a completely insane concept. On one hand, we, as physicians are taught to evaluate the patients as individuals, have informed consent dicussions, and taylor treatments to the unique needs of the patient based on our judgments, training, and knowledge combined with the patient’s own health literacy, language proficiency, ethnic and cultural backgrounds, associated medical conditions, financial resources, and their own desires, and we are supposed to do it in the span of a 15 minute visit. P4P, in essence, discourages us from doing exactly what we have been trained to do by offering “cookie cutter” solutions to what are not cookie cutter problems. Does anyone really believe that some aloof administrators can develop viable P4P plans that can encompass everything that we, the “boots on the ground” have to accomplish. I think not. Having said that, P4P is H2S (here to stay).
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