It’s 430AM and I am wide awake. I might as well start my weekend ‘There’s work to be done” chore list.


One of these is filling out my CME credits. CME stands for “Continued Medical Education”. Physicians are supposed to earn so many credits per year in order to keep up their license. CME is met through attending conferences, and reading journals. I do mine via podcasts; twice a month I get batch of lectures, to which I listen in the car. This is not as fun as going to a resort for a weekend (tax deductible) but it is far more convenient and economical.

The trouble is: there is no good evidence that wracking up CME credits makes you a better doctor.  The State of Colorado doesn’t bother anymore on the grounds if there is no evidence of efficacy and it’s an expensive endeavor to monitor, why bother? But the other states do, somewhat on the cynical grounds it’s a money racket, but more on the notion ‘we have to do something’ to make doctors ‘good’.

Today’s CME lecture is titled “Substance abuse in adolescence”. Although the talk may be interesting, I don’t think this will improve my skills (I treat adults).  Most doctors I know attend CME they find interesting, not necessarily the CME they “should”.

The real trouble is everyone wants something in place to demonstrate doctors as ‘good’ but no one agrees on what this entails. What makes a good doctor?: So many opinions on this.

There once was an attempt for patients to determine this but the appalling conclusion was what makes a good doctor in patient’s eyes were mundane things (like being on time or getting a phone call) or worrisome (doctors who did whatever the patients wanted). “Bad doctors” often were the ones who set limits “No, you can’t have more Valium”.

Insurance companies determining what makes a good doctor is worse. You can imagine what they think constitutes a good doctor viz. saving them money and at patient’s expense.

Legible handwriting? The ability to pass written tests every five years? Positive reviews on Tripadvisor?  More CME credits than another? Fewest deaths?  No one really knows; no one has really good measurements.

In the end, word of mouth reputation (from peers or patients) may be the best barometer to ‘being a good doctor’. Unfortunately this ineffable measurement eludes the bean counters.

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