Does "population health" cheat individual patients of high-quality care?
Abraham Nussbaum, MD, psychiatrist and author of The Finest Traditions of My Calling, believes so. In a recent interview with Kaiser Health News, Dr. Nussbaum shared his unique view on the role of physicians today.
Here are the chief ideas behind his reasoning, which rejects standardized, mass-produced methods of care delivery.
1. Dr. Nussbaum rejects the consumerism view of patients that defines health as a good. "When you remember that being with the ill is a calling, then you remember that it is a tremendous privilege to be a physician. People trust you with their secrets, their fears and their hopes. They allow you to ask about their lives and to assess their bodies," he told KHN. He said that using language in the industry to describe health as a consumer good has led physicians to forget that medicine is a calling and that it is a privilege to treat the ill.
2. He believes quality improvement measures and checklists are not as successful as we think they are. Dr. Nussbaum cited a study published in the British Medical Journal that found quality metrics have not produced a significant reduction in mortality. He also said he feels checklists make physician-patient interactions too scripted. "The leaders of the quality movement's version of quality improvement developed out of industrial engineering, so they are always comparing the care of patients to things like the production of cars or the flying of airplanes," he told KHN. "People are far more varied than cars on assembly line or planes on the runway. So quality metrics always feel forced to me, especially for the more interactive medical encounters."
3. That said, Dr. Nussbaum does not think physicians should be free to do whatever they want. "Their thinking and decision-making should be held up to scrutiny. A physician's standard of quality should be evidence-based, but even more, it should be patient-centered," he said, according to the report. Dr. Nussbaum gave the example of helping a patient with chronic pain resume their normal activities, not just reduce their score on a pain scale.
Read the full interview here.
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