Mismeasuring quality in primary care

After several years of doing family medicine commentaries for Medscape as part of a collaboration with Georgetown University Medical Center, I recently wrote my first commentary as a clinician and faculty member at the Lancaster General Hospital Family Medicine Residency Program about my mostly unsuccessful pursuit of elusive “quality” bonuses and the problems with current metrics used to judge care provided by primary care physicians. Here’s an excerpt that discusses another notable perspective that inspired me to write about this topic: 

In a recent commentary, Drs. Christine Sinsky and Jeffrey Panzer distinguished “solution shop” from “production line” work in primary care and argued that though the medical training physicians receive makes us uniquely qualified to do the former, we end up spending most of our time and energy on the latter. Similarly, they observed that “most quality-improvement efforts have focused on improving production line–type measures and not on improving the conditions for sound medical decision-making and relationship building.” Being able to correctly diagnose and treat patients who come in for chest or abdominal pain, for example, counts less (or not at all) toward my quality score compared with the percentage of patients who receive lead screening or diabetic eye exams.

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