This is a video (21 minutes, 33 seconds) of my lecture given at the Summit at the Summit: A National Grand Rounds on the State of American Medicine. The lecture aired during the conference webcast on July 23rd, 2015. Conference lectures can be re-watched by registering at LetMyDoctorPractice.org. The transcript of my lecture appears below.
Quality in medicine appears to have been formally first addressed around the 4th century B.C.E. in a collection of approximately 60 treatises known as the Hippocratic corpus. These writings outlined diagnostic methods of physicians but also detailed treatment failures for the benefit of all.
The corpus’s most famous surgical text, On Fractures, opens with a promise to discuss mistakes:
“I must therefore mention which of the physician’s mistakes I want to teach you not to do.”
The quest for quality throughout the corpus was distinctly a personal matter, centered on humility and the challenges of medicine:
“Life is short, the art is long, opportunity fleeting, experiment perilous, judgment difficult.”
This is one of the most famous statements of the Hippocratic corpus–its focus noticeably removed from a world-group or professional responsibility.
An independent company, known as ProPublica, made healthcare news this week by releasing the complication rates of nearly 17,000 surgeons nationwide.
ProPublica is another one of these non-profit groups that has been granted charity status by the Internal Revenue Service. Their self-stated mission is investigative journalism in the public interest.
You should know that ProPublica claims to be supportive of the “little guy.” I, too, like underdogs, so I enjoyed reading on their own website about their goal to shine “a light on the exploitation of the weak by the strong… [to expose] the failures of those with power to vindicate the trust placed in them.”
Giddy up, ProPublica.
I also favor transparency in medicine. In fact, I wrote a book, in part, to outline my support for it. But, ultimately, what I care about most is taking back medicine. Returning the practice of it to those things that are really meaningful to patient care. And, in our modern era of excessive third-parties mooching off the healthcare system, my focus has settled in on chiseling away at the less meaningful.
With that in mind, I’ll tell you about the “Surgeon Scorecard” that ProPublica has now made public.
“Deaths from high blood pressure should plummet under Obamacare.“
That’s the title of a recent news story that got my attention.
The article was a press release about a study performed by several non-physician investigators with a background in public health. For those less familiar, public health relates to the science of population medicine, or what’s good for the group is good for the individual. Basically, four non-physician investigators sought to analyze the impact that the Affordable Care Act (ACA), also known as “Obamacare,” will have on deaths in this country due to high blood pressure.
Physicians in America get licensed by their state to practice medicine. This is a legal requirement. And, as you might imagine, lots of stuff goes into getting that license. You first get your education, then you take some tests, then you get more education, then you take more tests, then you get continuing education… And, you get the point.
There’s also something known as physicianboard certification. It’s really not supposed to have anything to do with the law; yet, admittedly, in recent years, the controlling organizations that hand out these board certifications have gotten some of it written into law. But, that’s another story.
The concept of medical board certification was formally established in the 1920s and 1930s. It originated from “people” seeking to answer the question: how do you know your doctor is competent?