Transforming Health Care

Get ready to have your mind blown.  The Wall Street Journal published a huge piece entitled “The Simple Idea That is Transforming Health Care“.  You want to know what that idea is?  It is called QUALITY OF LIFE.  Confused?  Yeah, me too.   I thought the objective numbers of cholesterol, blood pressure, blood sugar and so forth was all there was to this job?  (Please note the sarcasm).  I guess it seems subjective measures of how people feel about their condition and overall well-being are important as well?  That’s weird.  How do we measure that?   The truth is that we can’t.  Oh, some idiots will try because they want to justify their job (administration).   So now the race is on to jump on this bandwagon.

An independent group that advises the government on health policy, called for a new national action plan to identify programs that help those with chronic illness and the population as a whole “live well”—reflecting “the best achievable state of health that encompasses all dimensions of physical, mental and social well-being.”

If you can explain that sentence then you are a goddamned genius, Private Gump.

To summarize, patients are more than their numbers.  They are people.  Instead of putting a nail in the coffin to the concept of paying doctors depending on their patients’ numbers this will just add more confusion to the mix by paying doctors’ depending on their patients’ quality of life.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “Transforming Health Care

  1. Bill Ameen, MD
    May 3, 2012 at 11:48 am

    Dr. Doug,
    I read that too, and tried to read it twice, to see if I could get any sense out of it. I’m wondering what a patient’s “quality of life” has to do with me. 99% of QOL, whatever that is, is determined by a person himself or herself. The right choices in life are pretty easy to make: Why doesn’t everybody know that Big Macs, too much booze, and cigarettes are bad for you? And also, a lot of my patients are stressed out by relatives, spouses, children, crappy jobs and the like, which do just as much harm. But none of this has anything to do with me, except that I supply the benzos that keep them sane! Good luck with the move back to VA, Doug! Maybe I’ll see you at the 25th anniversary of the Virginia Film Festival Nov. 1-4. I’ll buy you a beer at Littlejohn’s or a burger at Gus’s, speaking of bad lifestyle choices!!

  2. Dave Hoffman
    May 2, 2012 at 2:03 pm

    Wouldn’t it be hilarious if we could measure how good a patient’s quality of life was by whether they were happy with our care and therefore paid us for our services?

    • Doug Farrago
      May 2, 2012 at 2:11 pm

      That’s heresy.

  3. May 2, 2012 at 10:22 am

    We’re already asking patients for subjective opinions about their childhood such as whether it was “mostly happy” or “mostly painful” as opposed to “normal.” And whether life is “too boring” or “too demanding.” This a requirement for meeting meaningful use.

    I understand these subjective opinions have value to practitioners, but when the subjective opinions become measures of pay or patient satisfaction with their physician, we’ve fallen down the rabbit hole.

    Thanks for keeping the difference between subjective opinion and objective testing on the table. Perhaps if we pound our shoe on the table often enough, someone confusing the two modes will wake up.

    • Doug Farrago
      May 2, 2012 at 1:52 pm

      The truth is that they are both meaningless ONCE they become used for pay-for-performance.

  4. Kristin (mildly annoyed scientist)
    May 2, 2012 at 10:17 am


    As a caregiver for a mentaly disabled person I had some fun last week, I went off for 15 min to the local market and when I came home heard the Doctor had called, I returned his call and asked for the x-ray and lab results. Oops I don’t have the chart in front of me. Now this was 8 days after same doctor told me to call at 4PM for results and I was unable to reach him! Things esclated to getting the hospital and clinic management involved and I was now told we have to make another appointment to get lab results as they will no longer give them over the phone, oh the doctor instructed me to call for the labs I didn’t tell him what to do. Sweet way to rip off medi-cal for office visits!

    • drbonz
      May 2, 2012 at 2:50 pm

      Or maybe it’s a “sweet way” to obtain free medical advice with no regard for the physician’s time and no consideration for the fact that he/she sees patients all day but is still expected to make a million phone calls at the END of the day, FOR FREE.

      Also, a “sweet way” to avoid a medical malpractice suit for not appropriately following up on your patient and simply having a medical assistant read the results over the phone without appropriate explanation or opportunity for the patient to ask questions.

      • Bill
        May 5, 2012 at 8:14 pm

        duh ! the patient is mentally disabled so no questions to ask ! how about someone else giving the results WITH instructions to call for an appointment asap or otherwise where needed ! and if the MR patient needs to be transported back to the office, who pays for that ! NO EXCUSE for an 8 day delay when she was told to call back and did as instructed !
        a better system is needed for this Dr.
        and yes, caSE mgmt services should be compensated ! good luck getting insurance companies to do that !
        pick your battles, this one is a loser.

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