Report Cards

The newest rage with insurance companies and other busy bodies into doctoring is to issue "report cards" on doctors (box scores?) Those with A's will be rewarded (read $$$$), those with F's will be punished (read $). This is just a really bad idea. Why? Because the overwhelming majority of doctors are competent. You can't practice medicine unless you pass very strict qualifying exams. While there are really some outstanding docs out there (a New York Review of Books article on Harvey Cushing tells us that giants did walk the halls), most of us, though we would like to believe otherwise, are so-so. No, we will never live in Garrison Keeler's Lake Woebegone where everyone is above average. Unfortunately, in the real world, some of us are below average.

So what's going to happen? Well, its already out there. If you do a procedure that is risky, then you are not going to do it on high risk patients. Can't screw up your ERA's. There is going to be a gigantic Will Rogers effect.


Will Rogers, you say. How did he get in this discussion? Well, Will Rogers once said (and I paraphrase): "If you move all the Oakies from Oklahoma to California it would improve the average intelligence in each State." This is a well known effect in medical research where people are always moving low risk patients to high risk groups in order to improve their results (i.e., more patients in the high risk group survive.) Not intentionally, mind you. No, someone would never do that intentionally!

So, how does this work out with docs? Well, if I did high risk procedures I would only do them on low risk patients. You know, docs still do have a choice of who they take for patients. If you make every doc take every patient that comes to them (not a bad idea) then you can't penalize them for bad outcomes. Its as simple as that. Not that it won't stop this activity.

Why can't we have a report card on politicians? Particularly those in the White House. I'll give you one guess on their grade.