Quality, Quality, All Is
Obviously, this is a little play on the words in Ecclesiastes 1:2:
“Vanity of vanities, says the Preacher, vanity
of vanities! All is vanity.”
When I was a Duke freshman and had to read
both the Old and New Testament (the latter for the first time ever), Ecclesiastes moved
me like no other. It still does for to me the message in Ecclesiastes as in no other book in either Testament is that God is unknowable and each of us would be better
off getting on with our lives in a moral fashion. It also emphasized the
difference between Judaism and Christianity.
To me the essential verse in the New Testament appears in Romans 1:17:
For in it the righteousness of God is revealed
from faith for faith, as it is written, “The righteous shall live by faith.”
there is an unknowable God. Thus follow the 613 commandments to know what to
the truth and righteousness of God is found in faith.
And there you have it. The Jews say do this, do
this and don’t do this. The Christians say look into your soul and find your
faith and your faith will tell you what to do and what not to do.
Admittedly, this is rather simplistic, but it
has been nurturing for me since 1967. This juxtaposition allows me to acquire more and
more information about the two religions without having my head and heart
shatter for lack of a single cohesive philosophy. I ascribe to the Jewish one,
but believe that I understand the Christian one.
I wish I could be so certain of medical
In my talk that is based on my book Red Kool-Aid Blue Kool-Aid: How Partisan
Politics and Greed Undermined the Value of ObamaCare, (available on amazon
and other on-line outlets), I outline the three major tenets of health care
reform: increasing access which the ACA does to some extent; decreasing costs,
yet to be determined; and increasing quality, what the heck does that mean? I
also say in my talk that most people have no idea if the care they receive is
of high or low quality. How could they? Most of us know far more about our cell
phones than about our doctors. After all, your doc could be the guy who came in
last in his medical school class. He would still be called Doctor.
So in the two articles (links below) from
the NY Times in which quality is
discussed with regard to the new legislation likely to be signed into law that
will stabilize Medicare payments to doctors but eventually will base those
reimbursement on quality, all of us should be getting a bit queasy. The
government is going to decide upon medical quality? Oy!
There are really three kinds of quality.
The first is rather subjective and is usually
termed functional quality. We usually call it patient satisfaction and it is
measured with surveys that ask you a great deal about your “experience” as a
patient from parking, to the friendliness of the doctor’s staff, to whether or
not the lobby of her building had a Starbuck’s. To be blunt, patient
satisfaction is doodoo.
Second is technical quality in the form of
following checklists. This can appear to be quality but if everything is done
according to the checklist and you die, your family can still sue. I am not sure that checklists are any more
than a vehicle toward quality rather than quality itself. Important, but not really
The third metric of significance is outcomes.
Frankly, when I had my heart by-pass surgery and walked out of the hospital a
week later having spent all of 10 conscious minutes with Dr. David Ott my
surgeon, I was a happy camper. At the most important time of my consumption of
American health care, I was asleep.
So before we get too gleeful about the new
changes to Medicare, lets’ make sure we stay engaged as physicians and be
certain that what Uncle Sam calls quality we agree really is. Remember these
are the people who gave you Afghanistan, Iraq, Watergate, the invasion of the
gyrocopters, and Barack Obama.
As I said above, OY!