Secret #6 There’s also a third party’s agenda in the exam room.
From 11 Secrets of the Healthcare System Exposed
Your doctor is pressured to carry out someone else’s agenda during your visit, whether anyone likes it or not. It’s called “CMS Quality Measures*,” a misnomer because its definition of “quality” is not what you think. They measure the percentage of patients that meet certain metrics, like getting their colon cancer screenings, mammograms, flu shots, diabetes in control, high blood pressure in control, medication adherence, etc.
Because “annual physicals” are never used appropriately, because many people only go to the doctor when something’s wrong, and because it’s nearly impossible to get appointment to begin with… because they overloaded your PCP’s panel of patients, they found a way to force your preventative measures in at the most inconvenient times.
So while you scheduled because of palpitations, you might find yourself sitting there with your shirt on and underwear off, because the system told the nurse to set you up for a Pap smear. This is a true story, by the way. Like, why the fuck do I need to look at a cervix when the patient says they have palpitations and chest pain!? I need a freaking EKG, not a speculum! But I’m not blaming the nurse, because they’re also pressured to meet metrics, whether it make sense to do your Pap smear or not.
The system actually uses our competitive nature that got us into medicine to pit doctors and nurses against their own colleagues to see who has better numbers, or “compliance,” with meeting metrics. The ability to meet CMS Quality Measures (there’s over 40 of them) contributes to those 5 Star CMS Ratings. More importantly for the company, the 5 star rating means bigger revenue, like in the millions.
I’m not against preventative screenings, I’m just saying cramming more things into an already squeezed appointment does not translate into better quality of care.
And the next patient still has to wait.
Here’s another example that’s tracked by CMS:
What does quality measures mean in high blood pressure control? It means your doctor will keep upping your medication dose and add more medications until you reach the blood pressure goal, and keep you on that forever as long as you’re meeting the goal. (Or until you suffer the side effects.) Oh, and briefly tell you to eat low salt, walk more, etc. It’s the standard of care and not wrong, but is it the right long-term approach for every person? Is it your goal to stay on 3 blood pressure meds forever? Or do you prefer to really learn how to earn your way off of multiple meds? I think every doc would champion the latter, but the next patient is already waiting.
Here, we have a system that rewards doing more things to the patient, not doing things for the patient. It’s why surgeons and other specialties that do lots of procedures earn more than docs who’s jobs are mostly cognitive. It rewards quantity of care (fast-paced, high volume, like In-N-Out Burger), but not quality of care, which I don’t think is something that’s easy to measure, except in how you feel about it and if it empowers you with the knowledge, tools, and resources to help achieve your specific health goals. Quality care is personalized, holistic, collaborative, thorough, thoughtful, and that t a k e s t i m e.