A little-known fact about doctors that most patients would find horrifying is that physicians don’t keep track of their results.
If I botch a knee surgery so badly that my patient requires five repairs by a different specialist, I might never find out. As a result, I will continue to use a flawed technique on patient after patient. The fact that I never hear from any of them again will be proof, to me, of my incredible success.
We know from studies that malpractice suits have more to do with a physician’s bedside manner than actual negligence and that there may be an inverse relationship between a doctor’s online reviews and the quality of care that doctor delivers.
This means the average doctor has no way of knowing whether they are truly good at their job. Even scarier: they have no incentive to find out. If I repair a patient’s shoulder by only 70 percent, but I’m charming, on time, and my office staff is friendly, that patient will likely recommend me to their friends and write glowing online reviews. They figure, anyone would have given them a 70 percent shoulder and consider me a genius.
Conversely, suppose a less charismatic surgeon with a more disorganized staff performs a surgery that restores a patient’s shoulder to 100 percent. In that case, that patient may figure anyone would have given them a perfect shoulder and shy away from referring their friends and family to such a jerk.
I come out as the better of the two doctors and am rewarded with more robust business when, in fact, I should be taking notes from my gruff colleague down the street.
How can we fix this broken system? By measuring what matters. Teachers are evaluated by their student’s educational achievements. CEOs of public companies are measured by profits. Doctors, in turn, should be held accountable for their outcomes.
Clinical trials currently use patient-reported outcomes (PROs) to track the effectiveness of the treatment, drug, or procedure they are studying. PROs are reported directly by the patient, without interpretation by a health care provider. They are derived from a validated set of questions to measure symptoms, health-related quality of life, and other markers of how well a patient is doing following a medical event or intervention.
What PROs are not derived from is a subjective review of how nice a doctor is or how great the parking was. By tracking PROs, innovative health systems and physicians can bring the kind of data found in clinical trials into everyday clinical practice. This allows objective data to drive meaningful, patient-centric, and profitable changes to health care delivery.
Doctors who are currently tracking and reporting outcomes can validate what works and quickly change what doesn’t. Chris P. Dougherty, MD, team doctor for the Kansas City Royals and an orthopedic surgeon, said that by leveraging PROs in his practice, he has been able to “actively monitor our patients’ progress and document this in our medical records. We can positively prove our outcomes to patients and insurers, which is critical to our practice profile.”
PRO tracking and reporting are even more powerful when combined with confounding factor data and EMR data. This gives doctors a complete picture of a patient’s health, allowing them to select medications and treatments for “like” patients based on national or international data.
The only thing limiting the power of PROs to transform health care is their adoption. Some companies are encouraging physicians and health systems to bring more data into the practice of medicine. And it’s working.
The doctors who use our platform, for example, are alerted immediately if their patient reports a worsening in symptoms or has a new confounding factor affecting their health. This allows the physician to reach out to the patient quickly to help the patient correct course or avoid a complication, and it gives the doctor cumulative data insight to dial-in best practices. With these best practices insights collected from all their patients, the doctor truly knows what does and does not work in their hands. They are more likely to deliver the right treatment the first time, which is obviously preferable to the patient and reduces overall health care costs.
Right now, most doctors don’t keep track of their outcomes. To improve the health of their patients and the health of their business, they should.
Justin D. Saliman is an orthopedic surgeon.
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