Dr. Ebbert is professor of medicine and a general internist at the Mayo Clinic in Rochester, Minn. Yes, theeee Mayo Clinic. He wrote a recent opinion piece in Internal Medicine News that you may find intriguing. You see, he has been following yearly urinary microalbumin in his patients with diabetes even though they are already on an ACE inhibitor or an angiotensin receptor blocker. Why? Because he was “supposed” to even though he didn’t know what to do with the results. Why is he like every other doctor? Because like lemmings, we have believed in these stupid quality indicators, which, by the way, are unproven but “somewhere along the line, an annual microalbumin has been incorporated into performance measures and clinical algorithms” As Dr. Ebbert points out, the American College of Physicians just published a clinical guideline on the “Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease” (Ann. Intern. Med. 2013 Oct. 22 [doi:10.7326/0003-4819-159-12-201312170-00726]) and it “recommends against testing for proteinuria in adults with or without diabetes who are currently taking an angiotensin-converting enzyme inhibitor or an angiotensin II–receptor blocker.”
Dr. Ebbert ended his piece by asking,” How long it will take for clinical practice to catch up and remove this as a performance measure remains to be seen.”
I bet years!
This is one more reason metrics, quality indicators and pay-for-performance is WRONG for medicine.