Notes from the Office

January 12, 2013 in Shrink Stuff

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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Spo-Reflections Years 1&2

16 comments

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January 12, 2013 at 5:16 AM

David

I have the same concerns about continuing legal education (CLE.) About 45 states require CLE credits.

January 12, 2013 at 5:56 AM

anne marie in philly

spouse needs 18 CEUs per year to maintain his AAPC standing (american association of professional [medical] coders.

he obtains them by attending the local chapter meeting monthly and taking the quizzes in the monthly magazine.

now if only he could find a job in the field; he already works in the health insurance industry (and has done so for the past 21 years).

January 12, 2013 at 6:29 AM

justajeepguy

Most professions require some sort of continuing education.

It is a problem with most service type professions – medical, legal, education, financial – to measure performance. Unfortunately, results are unknown until long after the job has been completed.

As a retail manager, I devised (based on the book, The One Minute Manager) evaluations that were based on subjective and objective goals, goals which were given in writing at the time of hire and included a small percentage for the employee to evaluate themselves.

January 12, 2013 at 6:32 AM

William Fregosi

Clearly, the wrong processes are being used to evaluate practitioners in your profession. What’s needed to evaluate your progress and continuing development is a bubble test: YES!, a standardized multiple choice test put together by the good folks at Princeton, NJ. A typical question might read:

People who believe others are plotting against them all the time are:
A. reading about too many conspiracy theories online
B. in need of heavier doses of whatever promotional drug samples you
received
C. nutjobs who should be told to just get over it
D. absolutely correct as you’re plotting to stick another therapist with them

The test would take half an hour at most to complete online. You could then get back to brewing tea and making new barbecue sauce recipes.

January 12, 2013 at 7:36 AM

Sean R

Wow! An engineer, which I am, would say. “The easy solution here is to reduce the number of bean counters in the world. Make them get out of our hair and justify themselves some other way” (I’m saying this tongue-in-cheek. It’s hard to convey this in written form.)

My wife is a teacher by profession. They have the same problems in the education field. One could be the best teacher in the world, but if said teacher has students that refuse to learn, there are no “results” to be seen. The same problems apply for physicians. You can prescribe medication, but you can’t force patients to take it. You can advise and counsel, but you can’t force a patient to take your counseling to heart and more importantly take responsibility for their mental health. Then you get blamed when they can’t see the desired results.

I wish I had an answer for you.

January 12, 2013 at 7:50 AM

Laurent

What ever happened to a personal reputation as the benchmark for being good in your profession. It use to be that the simple fact that someone was known and had a good reputation was sufficient to attract clients. All these tests and appraisals are nothing more than our insecurity about the world, we need absolutes, black and white. We are in the age of the Wuss.

January 12, 2013 at 7:55 AM

Will J

I imagine that you know in your heart and mind what makes a good physician. The problem is that it cannot be measured. Listening, empathy, analysis, and the intellectual plasticity and curiousity to understand problems with social, physical, scientific, and emotional components and using the art and science of your training to propose realistic courses of action may be signifcant components.

I do not believe that there is a continuing education course that could possibly teach that.

January 12, 2013 at 8:54 AM

Ron

Prior to finding your blog and interaction with you, I was no big fan of “therapy.” In fact I was known for deriding the profession. However, since I have known you and listen to your advice, I am a better person. You bring out the best in me in your gentle, persuasive way. That is my test. You are a “good doctor.” You know what you’re doing and you do it well.

January 12, 2013 at 9:43 AM

Raybob

You wouldn’t imagine the hoops a mere massage therapist like myself must go through to get and document my continuing education. I wish *I* could just listen to a few measly podcasts!

But then again, MDs are the golden boys, aren’t they?

January 12, 2013 at 10:12 AM

Urspo

More like The Golden Girls

Sent from nowhere in particular.

January 12, 2013 at 10:26 AM

Jay M.

“Mere”? My massage therapist is probably as important to me as my personal trainer. I appreciate what y’all do, 100%!
Peace <3
Jay

January 12, 2013 at 10:14 AM

truthspew

Well, you can measure health outcomes right? I mean, take the study done some years ago where they sent M.D.’s out into the field to take care of disabled vets. What they found out was that it actually cost less and the health outcomes improved.

One example they had was the quadriplegic patient who would always get pneumonia. Once the visits started, the doctor could employ methods and procedures so that hospitalization wasn’t necessary and it wouldn’t evolve into full blown pneumonia.

The other thing to come out of the study? Under the old system the average annual cost was $45,000. Under the new system, $17,000 per patient.

That coupled with improved outcomes – to me that’s how you evaluate it.

January 12, 2013 at 10:25 AM

Jay M.

I guess as a patient I would have ideas about what makes a good doctor, and that they would be worlds apart from what the insurance behemoth thinks, etc. For me, in a nutshell, I love my doctor because 1) he only schedules one patient at time, typically no more than one or two an hour, so he gives me his undivided attention, and spends time teaching me about gaining better health. 2) He is up to date on current medical trends and treatments, and advises me accordingly. I admit I don’t always understand 100% his reasoning, but I trust his judgement. 3) He doesn’t hold punches – he tells me the way it is, and I guess 4) he is NOT a pill pusher. He’s taken me off more ill-advised medicine that he’s ever prescribed for me. I think I’m a healthier person because of his treatment over the years (going on 20 now), and even though his office is now almost an hour away, it’s worth the occasional trip (typically my yearly checkup since I’m not going to bother him if I have a cold or something like that that can’t be “treated” anyway!).

Peace <3
Jay

January 13, 2013 at 4:26 AM

Mitchell Block