Hippocrates — the missing duty

hippocratesHippocrates missed something big — a doctor’s responsibility to improve the care of other doctors.  OK he did get some things right — here are his points from the 5th century BC:

  • use good judgement — nice
  • revere your teachers — nice if you are a teacher
  • order a good diet — still a matter of question
  • don’t hurt or damage people — really or just statistically?
  • don’t poison people — makes sense to me
  • comport oneself in a Godly manner — doctors have no problem here
  • don’t do surgery if you don’t know how — duh
  • doctor visits should be for the advantage of the patient — patient centered care is nothing new
  • keep medical information private — HIPPA before its time

Doctors often take some revised or modernized version of the Hippocratic Oath.  Sadly, the idea that doctors have some responsibility for the care provided by other doctors is missing.  The idea is front-and-center in most work on quality improvement — where the idea is indeed to improve everybody’s care.  Doctors should have 2 responsibilities:  1) care for the patient and 2) improve the quality of care for all.

Most doctors don’t accept item #2, instead the list is:  1) care for the patient and 2) care for personal finances.  In essence, doctors shun quality improvement because “I’m not paid to do that”.

How many doctors participate in quality improvement activities?  Meaning, find a problem, make a plan,  do something, study the result, then act to improve the plan and repeat the cycle.  This is not rocket science.  A physician is not expected to do molecular biology research in the office but there is an expectation they will improve waiting time and reduce prescribing errors — things easily within their grasp.  How many physicians have a quality improvement meeting each morning or at least once a week — I dare say less than 1%.

Systems of care are very important.  But, the lack of physician involvement in quality improvement is a serious deficiency in many health care systems.  In some respects this is a structural issue for health care — it’s not a process, and it’s not an outcome.  It’s like a foundation for a house — no foundation means the house will not last.

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