Saturday, December 23, 2006
Who Should Enforce Standards?
Those whose eyes are caught by such things will have noticed the recent mention in the press of a study indicating that physicians who spent more time performing colonoscopies found more polyps. I happened to see it in the December 19, 2006 issue of the New York Times.
According to the reported study, the critical time period was during the gradual withdrawal of the scope, when the physician is looking for the polyps. Those who spent at least six minutes at this had the best results.
The NYT article went on to discuss how colonoscopy patients might use this information to select a physician to perform the procedure.
I thought the report noteworthy for two reasons. One was the ease with which the public now engages in public evaluation of how medicine is practiced – an indication that the profession is gradually losing its mystique. As medicine loses its mystique, its claim to professional independence and immunity from supervision weakens.
The other was what it implies about consumerism in health care. There is never going to be an easy or gracious way for the ordinary consumer to find out whether a particular physician takes more or less than six minutes to withdraw a colonoscope, or whether the physician’s polyp discovery rate is 25% or more (the standard quoted in the article).
It would be much better, it seems to me, if hospitals and group practices took responsibility for monitoring and enforcing standards of practice. I would like to believe that if I get my colonoscopy at the Leahy Clinic in Boston, Methodist Hospital in Houston, the Henry Ford Health System in Detroit, or the Myrtue Memorial Hospital in Harlan, Iowa, the institution makes sure that the gastroenterologists on its staff are all practicing according to accepted standards.
Those whose eyes are caught by such things will have noticed the recent mention in the press of a study indicating that physicians who spent more time performing colonoscopies found more polyps. I happened to see it in the December 19, 2006 issue of the New York Times.
According to the reported study, the critical time period was during the gradual withdrawal of the scope, when the physician is looking for the polyps. Those who spent at least six minutes at this had the best results.
The NYT article went on to discuss how colonoscopy patients might use this information to select a physician to perform the procedure.
I thought the report noteworthy for two reasons. One was the ease with which the public now engages in public evaluation of how medicine is practiced – an indication that the profession is gradually losing its mystique. As medicine loses its mystique, its claim to professional independence and immunity from supervision weakens.
The other was what it implies about consumerism in health care. There is never going to be an easy or gracious way for the ordinary consumer to find out whether a particular physician takes more or less than six minutes to withdraw a colonoscope, or whether the physician’s polyp discovery rate is 25% or more (the standard quoted in the article).
It would be much better, it seems to me, if hospitals and group practices took responsibility for monitoring and enforcing standards of practice. I would like to believe that if I get my colonoscopy at the Leahy Clinic in Boston, Methodist Hospital in Houston, the Henry Ford Health System in Detroit, or the Myrtue Memorial Hospital in Harlan, Iowa, the institution makes sure that the gastroenterologists on its staff are all practicing according to accepted standards.
