A P4P story

Since quality has many dimensions, we must worry that focusing on some dimensions will decrease our attention to other important dimensions.

The SGR Fix and quality measurement

They often do not want undesirable side effects from medications even if those medications are proven to help their disease.

For those who always blame organized medicine for problems, I hope you will rethink what these organization try to do.

Unfortunately, we who value the art of diagnosis are handicapped because diagnostic excellence is difficult to document with measures.

JAMA went into their archives to publish this 100-year-old article – Why Physicians Err in Diagnosis (subscription necessary)

The best detectives obsess, not willing to give up on finding the answer. They keep searching until the answer becomes crystal clear.

If we hope to decrease diagnostic errors, we must emphasize not labeling patients with a diagnosis until we have sufficient certainty.

We clearly should look to the airlines and how they use technology for airplanes. To not do so puts our patients at risk.

Recently we had another patient taking 80 mg of Lasix twice daily – and he had gained 50 pounds. IV furosemide worked beautifully.

So I accuse the system that was trying to improve quality as actually causing diagnostic errors and inappropriate treatments.