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...


  1. Superb stuff! I'm totally with you here. I also have a combination of rare and not-so-rare conditions (inc. Hashimoto's) that doctors have repeatedly failed to diagnose, or have diagnosed wrongly. They basically couldn't care less -- as in, they're not interested -- but it's taken me years to realise this, and to realise that I'm the one that has to aggressively pursue the blood tests I need, get answers relating to those results, and push for treatment. I know many people who have given up, and literally faded away. So keep on being feisty and getting what you need. And shouting about it. Thanks for the great blog.

  2. I couldn't agree with you more. My thyroid problem wasn't discovered until after a specialist had declared that I was depressed. The next doctor did a simple blood test and it was obvious what was wrong with me. How can patients hold doctors to account? Right now the only mechanism seems to be Physician rating websites.

  3. Yeah. I have Postural Orthostatic Hypotension Syndrome, which is small and non-threatening, as diseases go. And like you, it took me multiple trips to doctors to get a diagnosis - and finally, when we did the diagnostic test, the doctor never even called me back to tell me what the results *were*. (I happened to know what they were, because Google exists and it's a simple enough test to interpret, but still.)

    I think it comes down to the divide between inpatient and outpatient medicine. There are procedures in place (Mortality & Morbidity Conferences, etc.) in inpatient facilities to make sure that doctors are held accountable for mis-diagnoses. But in outpatient areas? I don't know what there is, except for the desire to do your job well, help patients, and not be sued - all good things, but not really external motivators like the M&M conferences are.



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