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"Two issues per visit" the future of primary care?


@patriciaborns  A resident physician at Boston's Brigham and Women’s Hospital, Dr. Joshua Liao ponders the by-the-numbers direction that doctoring is taking as big data drives the delivery of healthcare.  

In a personal narrative for the Boston Globe, Liao describes a new patient who's clearly disturbed about her brother's suicide attempts, but is afraid to talk about them. She confides that her previous primary care doctor told her "she could discuss at most two issues at each visit. This was the rule everyone would eventually have to follow, he told her, the 'way primary care was going.' In response, she learned to raise only certain concerns, a process that increasingly included ones that her doctor wanted to discuss."

While her doctor had focused on her cholesterol, blood pressure and tobacco use, events in her life overpowered her ability to change them. The doctor advised her he could only help people "who are committed to meeting me halfway," and advised her to see someone else. 

"More and more hospitals are using data to monitor physician performance and pay them based on these measurements," says Liao. "The difference now is that with large amounts of specific data, hospitals can track doctors more comprehensively and quickly than ever before. Proverbial carrots and sticks can be offered to nudge doctors toward desired performance cut-offs."

But as many doctors turn to a data-driven practice, Liao urges them not to change doctoring's underlying philosophy.   

"There are aspects of the human experience that are hard to account (or “risk-adjust”) for. And there will always be outlying, intangible qualities that mark good doctors and good care." (Read more.


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