Ratings have become a national obsession. U.S. News & World Report rates colleges, medical schools, hospitals, subspecialties, etc. Some private firms develop physician ratings. Many insurance companies provide physician report cards. Intuitively most physicians understand that these ratings have serious flaws, yet they persist.
Here’s a quote from a Malcolm Gladwell article that I had read and forgotten: “The Order of Things: What college rankings really tell us“:
A ranking can be heterogeneous, in other words, as long as it doesn’t try to be too comprehensive. And it can be comprehensive as long as it doesn’t try to measure things that are heterogeneous. But it’s an act of real audacity when a ranking system tries to be comprehensive and heterogeneous — which is the first thing to keep in mind in any consideration of U.S. News & World Report’s annual “Best Colleges” guide.
Consider hospital medicine. What skills make one an excellent physicians? Here is my attempt at a list; please suggest additions in the comments and will revise and give credit:
1. Diagnostic accuracy and persistence. Like a fictional detective, the best hospital physicians strive to get the correct diagnosis and often portray skepticism over previous diagnoses.
2. Bedside manner. Generally, we see patients for the first time. We have to create a comfortable, non-judgmental atmosphere to enhance history taking.
3. Honesty. We should make certain that patients understand our uncertainties and why we are doing testing.
4. Education. We need to explain all testing and treatments to the patient, and, if desired, also to family members.
5. Understanding. The best physicians focus on patient-centered investigation and treatment. They determine the patient’s expectations and do their best to meet those expectations.
6. Treatment. Once the patient has a diagnosis, the best physicians order treatment that takes into consideration the patient’s other conditions and the side effects that one might expect.
7. Team leader. Often we need consultants — the best hospital physicians ask consultants to help with specific questions.
8. Discharge planning. When the patient is nearing discharge, the hospital physician needs to consider many variables to make the transition to home or skill facility smooth. This includes understanding the patient’s home situation, the cost of medications and devices, the appropriate outpatient follow-up, etc.
Our report cards will focus on whether we meet certain performance metrics. Few metrics truly address the dimensions that I have described here.
Our report cards cannot reflect how we function for our patients because we likely cannot really develop measurement tools for many of these dimensions.
Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.
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