Wednesday, February 2, 2011

Quality in Medicine, the Lack Thereof

What strikes me as I continue to navigate the mess we call medical care is how poor performance festers unchecked. If I screwed up as often as medicine does and in the passive-aggressive manner it specializes in, I would have been fired from my last job.

Yet the doctors I've seen continue on their merry way.

Where is the quality control? Where is the accountability?

For instance, let's look at my diagnosis of Hashimoto's.

The first endo gave me the diagnosis simply based on palpating my thyroid and in light of family history.

The second supported the diagnosis before the blood work came back, but at least they ordered blood work. They never called me to follow up on the results or anything, which makes the blood work sort of useless, but okay. (What is the point of ordering blood work if you're not going to interpret it and DO something with it? The doctor is just wasting the patient's money.)

The third endo questioned the diagnosis and ran more blood work for even more antibodies because they weren't impressed with the previous bloodwork and said I don't have Hashimoto's.

Here's a revolutionary idea, why not run all the blood work upfront? I mean ALL of it and then decide if it's Hashimoto's or not. Take the cost of the doctor visits vs. the blood work and factor in the opportunity cost of one patient using resources across three physicians and tell me what is more efficient, accurate and economically feasible?

Hashimoto's is relatively simple stuff medically. It's common. There's a diagnostic test. So why does it take three endos to sort it out?*

It's half-a$$ed. If I had handled my job in the same manner, first, I would've blown something up with my incompetence, second, I would've been fired as well as faced civil charges and fines from the government.

Further, I was living with the supposition that I had Hashimoto's and avoiding quite a few vegetables as a result. Imagine if it hadn't been Hashimoto's but something that required more drastic lifestyle changes? All based on a bad diagnosis.

Why is this acceptable? Why is there no feedback mechanism in place to take situations like this and use them to improve the practice of medicine?

*I guess this explains why getting decent care for adrenal stuff is so difficult. If they can't handle a simple thyroid...

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