Monday, July 16, 2007
...Nevertheless, doctors generally assume that the high priority that they place on health should be shared by others. They find it hard to accept that some people may opt for a brief, intense existence full of unhealthy practices. Such individuals are pejoratively labeled ‘noncompliant’ and pressures are applied on them to reorder their priorities.”
This is what H.L. Mencken had in mind when he remarked that “hygiene is the corruption of medicine by morality. It is impossible to find a hygienist who does not debase his theory of the healthful with a theory of the virtuous. The whole hygienic art, indeed, resolves itself into an ethical exhortation. This brings it, at the end, into diametrical conflict with medicine proper. The true aim of medicine is not to make men virtuous; it is to safeguard and rescue them from the consequences of their vices. The physician does not preach repentance; he offers absolution.” Whether or not you agree with Mencken’s view of the physician’s proper role, the danger of transforming a doctor’s orders into the government’s orders should be clear.
This is what worries me the most about the current trend toward "pay for performance," in which doctors are rewarded if their patients meet certain health goals - diabetics keeping their blood sugar within acceptable ranges, people with coronary artery disease keeping their cholesterol levels below certain levels, for example. (Having patients weigh in at healthy levels isn't one of the quality measurements at the moment, but it could be eventually.) By tying physician payment to patient behavior, we run the risk of turning even the most libertarian physician into a tyrant.
posted by Sydney on 7/16/2007 08:17:00 AM 6 comments
Worse, you risk turning even the least compliant patient into a pariah.
By 9:17 AM, at
Politicians have a bottomless thirst for ever greater tax-inflows, which their authority to spend enhances their political power (and their sense of personal power).
By 11:34 AM, at
Pay for performance is just an economic construct. I don't see any moralizing in it at all. The gov't wants doctors and patients to hit certain targets (which at times seem quite unreasonable, but that's a different problem). The fact is that having relatively normal BGs, or receiving aspririn post-MI doesn't make one more virtuous, it makes one cheaper to insure. (And healthier, too, but that's just part of the goal).
By 8:33 PM, at
Reminds me of the neighborhood committee where I grew up. People with far too much time on their hands caring about trying to dictate the lives of others. The sad part about this is that normally it's one or two people leading the bunch. Normally through fear and intimidation.
By 10:49 AM, at
Actually, the cost savings from these measures are far from clear. Keep in mind that we are not taking about cost-effectiveness measured in the cost of QALY but actual savings. But while some measures may be cost-saving (e.g. blood sugar control of diabetics), other measures cost several times more than they save -mammograms or statins for primary prevention (especially if they are overprescribed as they often are) are prime examples.
By 11:04 AM, at
you pretend that doctors aren't already tyrants, but every chronic pain patient knows better. i haven't met a doctor yet who has the ethics to put my quality of life before theirs...
By 12:36 PM, at