Charlotte Yeh, MD, emergency physician and chief medical officer for AARP Services, herself became a hospital patient after being hit by a car while crossing a street in Washington, DC. Despite excruciating backside and knee pain, she wasn’t seen by an orthopaedist for almost 48 hours. In her recent Health Affairs critique of the health care system she encountered, she argues that medical metrics need to be rebalanced to include both the clinical and personal. Rebalancing will require three things, she said:
De-emphasizing the culture of testing. “When a test…is the centerpiece of care strategies, patient care can be compromised,” Dr. Yeh writes.
Making care personal. During four days in the hospital, no one asked Dr. Yeh how she was doing. By contrast, while in a post-discharge rehab facility, she said “personalized patient care was the rule, not the exception.”
Measuring patient-reported outcomes. No one in the hospital seemed to care about Dr. Yeh’s reports of her own condition. “Going forward,” she writes, “quality metrics should give more weight to patient-reported outcomes.”
In turn, achieving those three things will require that all clinicians focus on “mastering the skills of listening, empathy, and patient partnership,” Dr. Yeh concludes.
When it comes to knowing the costs of the devices they implant, orthopaedic surgeons and residents are batting only .210 and. 170, respectively. More than 500 orthopaedic surgeons surveyed at seven US academic medical centers correctly estimated the cost of common orthopaedic devices only 21% of the time. Residents at the same institutions did so only 17% of the time. Many of these respondents (36% of surgeons and 75% of residents) admitted that their knowledge of device costs was “below average” or “poor.” All respondents tended to overestimate the price of low-cost devices and to underestimate the price of high-cost devices. The implication of that tendency, say the authors of the Health Affairs study, is that “physicians may underestimate the amount that could be saved by choosing the lower-cost alternative.” The biggest barrier to physicians knowing device prices is confidentiality clauses in the contracts between device vendors and hospitals. “Widespread dissemination of device prices is not an option at many institutions,” wrote the authors. It remains to be seen whether the proliferation of accountable care organizations, with their emphasis on cost-efficient care, will alter this situation. For more about cost variation in orthopaedic devices, see the JBJS article “Variability in Costs Associated with Total Hip and Knee Replacement Implants.”