By David Albert Newman
August 3, 2010
This post discusses a very strong point of interest of mine: quality over quantity health care treatment.
This article shows the Canadian Medical Association (CMA) advocating pay for performance based upon quantity of patients treated.
A piece rate system (pay for performance) based upon the QUANTITY of patients treated is NOT a good solution. That rewards expedient performance. That is the problem with the current health care system: patients are treated TOO quickly by doctors when they finally see them after waiting for too long and the patient ends up with suboptimal care.
The solution: pay for QUALITY of CARE measured by LESS FREQUENT follow up appointments and/or fewer hospitalizations from conditions that could have otherwise been treated sooner or better.
Quality over quantity better manages the health care operations bottleneck: waiting times. I have studied this in my MBA Operations Management course about queuing theory and line balancing to manage the bottleneck by adding resources to equalize a system flow.
We need to adopt a new model of health care that I have coined: Think. Consult. Reflect. Act. (TCRA).
Doctors rely too much upon their own knowledge and skill rather than consulting a peer for his or her thoughts and a second opinion. That is extremely rare in professions.
The consult may take more time up front BUT in the long run the patient may recover with fewer repeat contact points to the health care system.
This is important since while many doctors think they are infallible, they are like the rest of us: they make mistakes AND their mistakes are often more serious due to the nature of their work of treating human beings who are ill, either acutely or chronically, and who may be getting worse.
It's time to change the culture of doctors to REQUIRE that they consult UNLESS IF and ONLY IF the diagnosis and treatment is very routine.
The current system BEFORE a negative change to a piece rate system of pay for performance relates to my poor health care treatment when I had ulcerative colitis in my mid-teens that almost killed me (I went to hospital at 98 lbs at 5' 10" tall and I was there for a week or so). This family physician not only did not diagnose my ulcerative colitis, he provided medication that moved food through my body faster since he thought I had an ulcer. That exacerbated the already chronic diarrhea that was dehydrating me and leading to my rapid weight loss. Thus, he broke the rule of non-malfeasance in the duty of care for me as the patient.
As for my mental health care, I was diagnosed incorrectly during 2000. I can't recall if the doctor was a psychiatrist or a psychologist, but based upon talk therapy, he must have been a psychologist since psychiatrists rarely perform talk therapy; rather the psychiatrist is a pharmacologist toward mental illness treatment.
During 2000, the psychologist stated that my long dead grandmother did NOT have schizophrenia even though she had finally been diagnosed with schizophrenia by a very prominent Winnipeg psychiatrist when she was quite old; how can a subsequent psychologist make a differential diagnosis about a relative, my grandmother, who had been dead for years and then extrapolate to me that I also did not have schizophrenia even given my paranoid behaviours of my wall posters staring at me and persecuting me? I was treated for anxiety with medication that controls the heart rhythm. This too is an act that broke the rule of non-malfeasance in the duty of care for me as the patient.
That is a SERIOUS error since I suffered for 5 more years before being hospitalized three times during 2005 where I finally received the diagnosis of schizophrenia (with depression and anxiety as a result since I could not recover properly and I had no idea at the time before diagnosis what was wrong with my brain, along with the following reality). I had lost all jobs, I had no positive cash flow income, I almost lost my house, and I almost killed myself since I was highly suicidal. The EI system funds ran out and then they came back at me for not properly declaring the little side income I did earn in my poverty.
I would have been gone and not only my family and friends would have lost me; I believe in myself and my ideas and the world would have lost those too.
The underlying problem in my case for both the family physician and the psychologist: no peer consult and over confidence in their knowledge and skills to properly diagnose completely ignoring me, the patient, and the input from me and my family. The CMA does have one thing correct: the patient MUST be the center of care. That is the whole point of the health care system.
I think the Hippocratic Oath needs to be recalled by all medical doctors regardless if they are a general practitioner or a specialist. This patient was almost killed twice by insufficient and inappropriate medical treatment and it is not only my goal, it is my moral duty, to minimize that same occurrence for other patients who may be too ill to fight for their human rights of proper health care treatment in Canada and elsewhere in the world.
David Albert Newman, CGA, CIA, ACCA (UK), B. Comm. (Hons.) with Distinction
"Anything is possible if we let our mind wander away from standardization towards creativity."
