Apr 9, 2009

Timeout? No thanks. With stakes this high, I’d rather keep working.

As a medical student who is both only weeks away from graduation (Duke, please don’t withhold my diploma) and a long-time admirer of Dr. Groopman’s work, it is with some trepidation that I respond to the recent opinion piece in the Wall Street Journal “Why ‘Quality’ Care Is Dangerous” by Jerome Groopman and Pamela Hartzband.

However, the issue of healthcare quality improvement is too important for me to ignore such a potentially damaging editorial. Strangely, the article reminded me of a variety of clichés often used to argue against well-intentioned words of caution (such as those of Groopman and Hartzband) including, “Don’t throw the baby out with the bathwater;” “Don’t let the perfect be the enemy of the good,” and “Rome wasn’t built in a day.”

These clichés aren’t excuses. Progress has got to start somewhere, and while we have a long way to go, patients are far better off today than they were in November of 1999 thanks to the myriad efforts of so many dedicated quality improvement champions. Unfortunately, Groopman and Hartzband give only a brief nod to this progress.

By largely ignoring the successes and claiming that early missteps in particular quality efforts (namely public reporting and pay-for-performance) are examples of the system gone awry, the authors are doing patients and medical progress a serious disservice. They call for a “time out” in the progression of our healthcare system towards increased accountability and improved quality. (And let’s ignore for a moment the potential harm caused by the title of the article which implies that the entire spectrum of quality improvement efforts is dangerous).

Are there problems? Yes. Are there inherent risks in any major changes to a system as complex as the U.S. healthcare system? Of course. In fact, the article articulates many of the risks and, to date, failures of some of these efforts (which I hope to discuss in more detail in a follow-up posting). However, those of us who are patients, have friends or family who are patients, take care of patients, or simply pay taxes, should not accept the “time out” called for by Groopman and Hartzband; especially since I don’t remember seeing any breaks or timeouts in continuous quality improvement cycles.

- Duke University Medical Student, c/o 2009


Eva said...

Click here to read the article published in New England Journal of Medicine about the NICE-SUGAR study that evaluates intensive glycemic control.

Eva said...

Dr. Don Berwick and others respond to the Groopman commentary. Click here to read!

A.H. said...

correction to the link posted above. read Berwick's (and others') comments here: