Health Provider Quality

In the course of my 20+ years in health care, there have been times when I have had to cringe at the low quality care being given by a particular provider. It is a helpless feeling. For patients, I think there is an assumption that all providers are created equally. Or, in other words, if someone has the license as a medical doctor, nurse, physicians assistant, etc., then they have to be a good provider. Not true. And there is no credible way for the public to determine the quality (or lack of quality) any given provider brings to the table.

Certainly, one can perform an online search to see if their provider has been disciplined by his/her state licensing agency. Often, this data is state specific and doesn't include data from other states. It is possible for a provider to hop from state to state to try and avoid losing a license or avoid disciplinary action.

By and large, all those who practice with a valid license for their vocations are competent and provide adequate care. But the real data, patient outcomes, is like a vapor. It is not gathered, in most instances, and is far from being subjected to good analysis. To be sure (as if we all didn't know this) outcomes matter. And sometimes the least noticeable practice decisions can have the biggest impact. There is a massive, disjointed effort underway to gather more data with the implementation of electronic medical records. Most that I have seen, or am aware of, track what they are told to track. This mostly includes markers of "evidence-based medicine" and check box care. Care sometimes devolves into a cookie cutter routine. This "dumbs down" provider practice instead of elevating it, in my opinion. Most patients fall in the big fat part of the bell curve and do well with this kind of practice. But not every patient or every problem the patient has, fits nicely into this context. Additionally, evidence-based medicine is tenuous at best. There are myriad ways to contaminate data and recently there have even been allegations of outright fraud in establishing best practices (to wit Dr. Scott Reuben).

I think, in some ways, check box, evidence-based medicine protects the sub-par practitioners. Alas, the issue of unknown provider skill and competence level will continue to be a problem until we are able to establish good ways to track patient outcomes.