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Posts Tagged ‘great medical care’

An August 3, 2010, article in The Washington Post discussed rating systems for doctors, pointing out that current doctor rating systems are “rudimentary” and “may not reliably reflect a doctor’s abilities.”  Well, yes and no.  When it comes to measuring technical aspects of diagnosis and treatment, there  is probably no reliable system that reflect a doctor’s abilities.  On the other hand, we have excellent systems, DrScore.com among them, that are able to reliably assess patients’ satisfaction with their care.

The Post article points out that the standard way to find a doctor is to ask friends and family members for advice or to trust a referral from another doctor.  These are very reasonable, albeit limited approaches.  Online systems that assess and report patient satisfaction are extensions of the “ask friends and family” approach.  These systems may not be a reliable measure of a doctor’s ability to make a diagnosis and prescribe an accurate treatment, but they are a reliable measure of how happy patients were with the care they received.

And that is something worth knowing.

A tremendous advantage of an online rating system like DrScore.com over the traditional friends and family approach is that the online data collection allows doctors to find out how they are doing, a critical tool to help doctors do what they want to do most — give their patients great medical care!

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Sometimes, there is  not one right answer to the problems faced in medicine (or in any other field).  For example, we want drugs that have awesome efficacy.  We want drugs that are extremely safe.  We want drugs that are affordable.  It’s not likely we’ll get all three (or even two of the three) at once.

Providing the best information about prescription medications to patients is another conundrum.  As pointed out in a recent publication (Winterstein AG, Linden S, Lee AE, Fernandez EM, Kimberlin CL. Evaluation of consumer medication information dispensed in retail pharmacies. Arch Intern Med.  2010;170:1317-24), the law requires that most prescriptions be accompanied by useful written consumer medication information.

But what does “useful” mean exactly?  Putting together a “useful” handout that is readable and has the basic information is certainly going to help patients, but it is also presents a risky situation for the manufacturer.  Of course “useful” information includes material that is understandable and necessary to understand and correctly use the medication.  But should every side effect be included?  Where do you draw the line between side effects that are common and those that are too rare to include?  And if you do exclude any, how would patients feel if they developed a known rare side effect that was left out of the brochure?

National Public Radio quotes Joe Graedon — a pharmacologist, host of the People’s Pharmacy and an expert on practical drug information — as saying that there are only a few key things people really need to know about their drugs:

  • how to take the drug
  • the most common side effects
  • symptoms to watch out for and what to do if they happen

That’s sensible advice.  However, there are many of lawyers out there — you’ve seen their ads on TV.  With so many of them around, how will people justify excluding information for patients  about even the rarest of risks, and making the brochures so long and so technical that they are no longer considered “useful?”


Note: I have been a big fan of  Graedons’ Peoples Pharmacy program for years and have been a guest on the show a few times.  You should check it out here. It is a terrific medical resource.

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Make sure you check out the Getting Better Health Care Radio Program on webtalkradio.net. My latest interview is with Dr. Nancy Oriol, founder of the award winning Family Van program in Boston. She tells us about the barriers to accessing our health care system and how reaching out to the community can help reduce those barriers.

Want to reduce your health care costs? Don’t miss my interview with Dr. Cynthia Koelker, author of 101 Ways to Save Money on Healthcare.   She tells us how we can save money on preventive care, including information on which screening tests we need and which we don’t.

The previous show with David Coates talks about the politics of making needed changes in our health care system.

Another show not to be missed is the interview with Dr. Sandra Kweder, Deputy Director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research.  She explains what the FDA does to assure that marketed drug products are effective and safe.


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I received an e-mail invitation to attend a medical-legal seminar on reducing risks. I’m not sure what they are going to cover, but clearly, the No. 1 way to reduce medical legal risks is for doctors to give patients great quality medical care. Patients also need to perceive the quality of care is great. That is why obtaining feedback from a patient satisfaction survey service like DrScore is a necessary component to assessing and assuring patient satisfaction.

Great medical care is really a partnership. Patients can reduce their risk of being in the kind of situation that results in medico-legal liability by taking more responsibility for their own care. Patients should get a copy of their medical records, particularly the results of laboratory work that is done. That will help make certain nothing falls through the cracks in a system that has shown itself to have too many cracks.

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Doctor patient communication

The Archives of Internal Medicine reports that communication between doctors and patients isn’t always what it should be.  The study of 89 hospitalized patients found:

  • Of the 73% of patients who thought there was 1 main physician, only 18% could name the physician
  • Only 67% of the physicians thought patients knew their names
  • Only 57% of patients knew their diagnosis
  • Only 21% of physicians said they always provided explanations of some kind
  • 90% of patients getting a new medication said they were never told about any side effects

The researchers concluded that steps to improve patient-physician communication should be identified and implemented.  Boy, is that an understatement!

To start, perhaps doctors could leave each patient a business card with the doctor’s name on the card.  That would help patients know their doctors’ names.  Even better, have a line on the card where the diagnosis could be written.  I’d include the doctor’s cell phone and e-mail address to help enhance communication between the doctor and the patient and their family.  And perhaps the doctor ought to have a checklist of things to do so that whenever a new prescription is given, the patient is given a written explanation about the medication, including the potential side effects to look out for.

Of course it would help for every patient to be given the opportunity to give their doctor feedback through a system like www.DrScore.com to identify these kinds of problems and solutions to them ASAP.  A “Please give me feedback at http://www.DrScore.com” would be a nice addition to that business card.

We are so invested in improving medical care, with billions and billions of dollars going to the development of new treatments that may someday help someone.  Just a little common sense and some inexpensive solutions could be done right now to enhance the care that most patients receive.

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The AMA and 47 state medical societies authored a letter to insurers about the unreliability of “claims-based” doctor ratings. Claims-based studies use the billing information doctors send to insurers to assess the quality of the care that is delivered. The AMA letter cited studies by the RAND Corporation showing the limitations of these studies.

The AMA hasn’t offered a better way to assess the quality of care doctors provide. Measuring the quality of medical services that doctors provide is extremely complicated, especially because we want doctors to tailor treatments to each patients’ specific needs, preferences and desires.

One aspect of medical care that may be most easily measured is patient satisfaction. This is what we measure and report at DrScore.com.

Patients always know how satisfied they were with their experiences, and there’s growing recognition of the value of patient satisfaction measurement. Government reimbursement programs covering health care may soon require patient satisfaction measurement. The medical boards that certify physicians may require doctors to document and report results of patient satisfaction surveys, too.

This is good news for doctors. Doctors give patients great medical care, and open reporting of that quality is bound to help the public see what a good job physicians are doing.

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Avandia, a medicine used to treat diabetes, has been the subject of news and controversy. Concerns have been raised about the drug potentially causing an increased risk of heart attacks compared to other treatment options. An FDA panel reviewed the evidence and voted 20-12 to keep Avandia on the market.

The controversy around Avandia is complicated. Concerns were expressed that the manufacturer may have downplayed or hidden evidence of problems with the drug. But so far, a detailed examination of the evidence didn’t lead the FDA panel to call for sales of the drug to stop.

In some of the latest news about the controversy, a couple of members of the FDA panel that reviewed the drug were found to have been paid in the past for services to the company that makes Avandia or by the company that makes the competing product (Wall Street Journal). I doubt this affected the panel deliberations or decision in any substantive way.

The bottom line is that understanding the safety of drug products is really quite difficult. In the case of Avandia, it’s easy (well, at least relatively easy) to show that the drug helps patients control their sugar level. It’s much harder to know if there’s a small increased risk of heart attacks or how big that small increased risk is. If you are taking Avandia, the best course is probably to speak to your doctor about it.

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