Doctors and Teachers

QM

For years I have pointed out the similarity between doctors and teachers. Two years ago I said this:

The teaching profession is ahead of us by a few years. Watch how it is crumbling and how some states are finally getting rid of the core competency BS. We need to do the same with the “quality” movement before it is too late.

Three years ago I said this:

I have highest regards for teachers. My mom was a science teacher. My wife was a special education teacher. If you have read this blog you know that I have used examples of what is happening to them to show how doctors are following in the same path.

and this:

Now let’s bring this to the healthcare system. You are making doctors quit with unproven benchmarks and quality indicators, ridiculous mandates, disrespect, EMRs and loss of control.

and even this five years ago:

Who knows but to give “quality” grades to doctors that depend on patients’ compliance is like basing teachers’ pay on the tests scores that their students achieve. Who is crazy enough to do that?

We are heading towards “No Patient Left Behind” which will fail miserably.

I point this out because the NY TIMES just did a piece called How Measurement Fails Doctors and Teacher and it just made me grit my teeth.  The highlights:

  • TWO of our most vital industries, health care and education, have become increasingly subjected to metrics and measurements. Of course, we need to hold professionals accountable. But the focus on numbers has gone too far. We’re hitting the targets, but missing the point.
  • All of this began innocently enough. But the measurement fad has spun out of control.
  • There are so many different hospital ratings that more than 1,600 medical centers can now lay claim to being included on a “top 100,” “honor roll,” grade “A” or “best” hospitals list.
  • Education is experiencing its own version of measurement fatigue. Educators complain that the focus on student test performance comes at the expense of learning.
  • But the objections became harder to dismiss as evidence mounted that even superb and motivated professionals had come to believe that the boatloads of measures, and the incentives to “look good,” had led them to turn away from the essence of their work.

Am I trying to gloat about my prediction?  Of course I am.  I also want to point out, however, that the idiots in charge of both our education system and our healthcare system are NOT going to give up that easily.  Why?  No one likes administrators.  You know it.  I know it.  They know it.  The most trusted professions in this country, by far, are doctors (and nurses) and teachers.  Administrators are no where to be found on that list.  So what is the best way to gain control over these systems?  You need to create distrust between patients and doctors or parents and teachers.  How do you do it?  You create a false need for bogus quality indicators and metrics.  You hire other administrators and call them consultants to publish studies “supposedly” supporting these metrics.  You control the media and what is said to the media.  You create a crisis in both systems. These crises, which infer that teachers and doctors need more oversight, create doubt in the public’s mind.  It allows administrators to hire more administrators.  It allows administrators to be the bosses they need to be in order to play chess with the jobs of doctors and teachers.  It allows administrators to get gold stars and top honors for their hospital and themselves.  It allows administrators to get paid a lot of money.  And that is where we are today.  Any questions?

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] 

  5 comments for “Doctors and Teachers

  1. Beth
    January 19, 2016 at 7:59 pm

    “The Managerial and Bureaucratic Class are stuck in a factory mindset. They will destroy medicine to save it, as they have destroyed education. In my state, my city, fewer than 50% of students GRADUATE HIGH SCHOOL. This was the benchmark for being well-educated 100 years ago – and half of our citizens come out without those qualifications.”
    Note that the people who are behind this push, like Bill Gates and Eli Broad, are people who became wildly successful in goal directed fields. As a result, they consider themselves intelligent and want to use their brilliance to remake all other fields. Since they can buy up the major media and the congress, we now have their perspective as a form of common sense. We are all widgets now.
    As a consequence, the big money in medicine are for those who manage the doctors. In education, teachers make less than they did 30 years ago. Do you want your children to love reading? Do you want your son/daughter to be able to think logically? Do you want your children to love learning? We can’t get there from here.

  2. Ben Van Raalte
    January 19, 2016 at 11:38 am

    Excellent summary

    Add to that online ratings. Online ratings for doctors (done anonymously of course, and cant be responded or refuted because of HIPAA) would be like junior high students rating their teachers. The teachers that were their friends, let them have fun, and gave no homework would get the best online ratings. Those that challenged them, gave homework would rate poorly. Doctors that hand out narcotics, give disability, give as much time off work as the patient demands, give them the medications they request, dont tell them to lose weight or stop smoking get the highest ratings. And get more patients because they refer their friends.
    Honest surgeons and doctors suffer.

  3. Perry
    January 19, 2016 at 10:53 am

    Patients and students are not widgets. They all come with different personalities, abilities and a huge range of socio-economic problems. Doctors can no more control for any of these factors than teachers, yet the “Talking Heads” (no disrespect to David Byrne) continue to push for quality measures intertwined with these problems and individual characteristics.
    There is not an unlimited supply of really good dedicated teachers or doctors to go around now, and all this BS is only going to make it worse. We will have a nation of professionals that knows how to “check the boxes”, but not how to teach, or practice real medicine.

  4. Cliff Norman
    January 19, 2016 at 10:39 am

    Doug, unfortunately, the use of ranking and applying measures to individuals without regard to the system for which they work has little to do with quality. Deming would go absolutely wild with the nonsense that is happening in education and now health care in the name of “quality.” Deming was very critical of such practices. We now have some teachers who are going to jail in Atlanta for cheating: http://www.businessinsider.com/atlanta-teachers-get-prison-time-2015-4

    Charles Goodhart (Goodhart’s law) once observed: “When a measure becomes a target, it ceases to be a good measure.” The idea of ranking and rating people has a long history and started way before “the quality movement.” Deming often gave the following equation: X + XY= 8, where X = Individual in the system and Y= System. He said it was impossible to solve the equation unless you were in management. Since you don’t have a clue about the system, then set Y=0, then X=8, any thing that happens can now be attributed to the Individual. Very sad. Both education and health care exist in complex systems, using simplistic methods not supported by good theory, is not good management and will lead to the nonsense we are seeing.

  5. Steve O'
    January 19, 2016 at 9:11 am

    -And both of them have been the subject of critical attention by Commissions, Institutions, Authorities and other agencies trying to introduce a benign, socialized homogeneity into each profession.
    -Both are “process-directed” jobs, not “goal-directed jobs.”
    -Manufacture is goal-directed. Producing widgets is what the mathematicians call PATH-INDEPENDENT. A good widget can be produced by many different processes. The only goal is making a perfect widget (according to tolerances.)
    -Excellent teaching and doctoring are ENTIRELY process-directed. They require that their method be individualized to each subject, each individual student or patient. There is no “generic” student or patient, and the Manufacturer’s Club hate it. They want to sell product, not method. Product manufacturing depends little on the competence of the assembly-line worker. Method-directed “work” depends entirely on the competence of the “assembly-line worker.”
    The Managerial and Bureaucratic Class are stuck in a factory mindset. They will destroy medicine to save it, as they have destroyed education. In my state, my city, fewer than 50% of students GRADUATE HIGH SCHOOL. This was the benchmark for being well-educated 100 years ago – and half of our citizens come out without those qualifications.
    -We are madly chasing the Third World. Countries filled with people who are only capable of the most menial labor CAN supply factory jobs, it’s true – but not at First World wages. The US offers good jobs in the bureaucratic, regulatory and management areas. How long can that continue?
    PS: I looked into a job at our state’s Disability Determination Division. I was so sick of the medical carousel that I applied for a fairly well-paying job which DIDN’T require medical training, not even a college degree. When they found out I was an MD, they offered me a contract/consultant job position for physicians at the same agency.
    SURPRISE! Accounting for the lack of benefits in the consultant’s position, the jobs PAID THE SAME. Guess which one they were having an AWFUL time recruiting for!? There were scads of applicants for the first job, which required enough literacy to read the newspaper.
    What kind of country are we making?

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