Good doctoring transcends numbers

Measuring metrics is a common catch-phrase in health care. The goal of capturing certain data is to improve patient outcomes. But, as doctors, we were taught to treat the patient and not the numbers. While optimizing clinical outcomes is a needed goal with all the complexities in medical treatment currently, the system seems to have gone too far in its quest for targeted numbers.

If, for example, a patient suffers metastatic breast cancer, the insurance company sees them as some variation of the ICD 10 code C50.919 (malignant neoplasm of unspecified site of unspecified breast). The treatments and diagnostic tests are then tied to that series of numbers. When requesting authorization for a potentially life-saving procedure, the representative punched in that code on their keyboard to see if it can be approved. If it doesn’t fit their data requirements, a battle ensues. It doesn’t matter how the patient is doing or any other circumstances. Yes, additional information can be submitted, appeals filed, and peer-to-peer requests done. But, all of this delays diagnosis and/or treatment and there is a significant cost in both time and dollars to navigate this maze.

Another example is the diabetic patient, who is seen as a function of their HbA1C, If you are at the goal that your insurance company pre-determined for all diabetics, all is good for the patient and doctor. If not, then those same representatives are not happy. They may send inquiries or make phone calls to the patient, wanted or unwanted. And they will send letters or even drop in to visit the doctor. In the future, the doctor stands to be financially penalized for the failure to meet this number. No consideration is given to the fact that the patient may have undertaking remarkable changes in their diet and exercise or that they were suffering an illness at the time the blood was drawn.

Patient-centricity and empowering patients is often spoken these days and should be the goal of anyone working in the health care system. The best medical care is the one that focuses on the patient. And patients will follow best medical advice only when they have invested in it and are given an equal share in making medical decisions on their own behalf. But, how can that be done when their numbers seem to be more important than their well-being?

True, we often only have numbers, such as blood test results, to gauge how a patient is doing. It is also a fact that doctors aim to reach certain goals in these numbers, such as certain cholesterol ranges, blood sugars, etc. However, if that is all we focus on, we have lost the patient. We need to be concerned about the total patient, physically and mentally. A patient with a well-controlled LDL-cholesterol level is not doing well if he/she is suicidal. Recent studies show that patients who have suffered a myocardial infarction have a higher mortality rate if they are depressed after the event. Clearly, data is not the only necessity in treating patients.

Doctors are increasingly pressured to meet certain metrics. If all my diabetics have good numbers but continue to eat high amounts of junk food, have I truly made an impact? There is evidence about clinical outcomes based on numbers, and we need to incorporate these into our practices. But, we need to look at the whole patient.

Teaching medical students who are required to do complete physical exams, it is often surprising to hear a patient say no doctor ever looked at their feet before. Often, patients tell us they saw the specialist who was too busy to answer their questions, and they are confused about their treatment plan.

We need to put the patient back as our main focus if we want to truly provide them the best care. We need to push back against those pressuring us to do more and more in less and less time. This is simply unsustainable in an environment of patient-centricity.  Third parties try to judge us by their established data. But, good doctoring transcends numbers.

Linda Girgis is a family physician who blogs at Dr. Linda.

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