What’s Wrong With Quality!?!


About five years ago, when I was an employed doctor in Maine, I was the “physician leader” for my particular office of three docs.  Pretty impressive, huh?  Actually, it was a pick the short straw kind of thing and if you lose then you have to be “physician leader” and go to stupid administrative meetings. Anyway, I had been cynical of the quality fad for ten years by then as I saw it creep its way into my life.  My first job in 1997 had the hospital executive show us a chart, a few weeks after hiring, whereupon the bonus structure was based on  an awkward RVU scale (don’t worry about not understanding this as no one does) as well as a “matrix scale”.  The movie The Matrix was not out yet so I don’t think the dude copied the name but the way the metrics of getting paid were explained it may have well been a scene from the film.  I believe “citizenship” was a measurement.  No lie. What the hell is that?

Back to my physician leadership role.  The meetings started out okay as I tried to be on my best behavior. I would survive by wondering away in my mind thinking of anything else other than the absolute boredom and nonsense being displayed in front of me. At this time I was still writing the Placebo Journal so I justified showing up because it made  it easy to produce good material.  It was when they brought up the new and exciting concept of measuring quality metrics that I couldn’t take it anymore.  No one was giving the downside!  All the doctors, and of course the administrator, just gushed over the concept.  Why would the doctors not protest this crap?  The reason was that most of them were ass kissers so they just wanted to get along. Others were just clueless.  I snapped.  I had read the book Zen and the Art of Motorcycle Maintenance so many times to know that Quality vs. quality created insanity in the main character. “Quality is a characteristic of thought and statement that is recognized by a nonthinking process. Because definitions are a product of rigid, formal thinking, quality cannot be defined.” So, as best as I could, I stood up and blew away their case for quality.  I just broke it down like a seasoned lawyer.  If the metric doesn’t fit, you must acquit.

I bring up my past to try and explain the future.  This article in Modern Healthcare is called How Perverse Incentives Are Ruining Healthcare and it basically reiterates some of my points from that meeting. I predicted it all.  My problem with the author, though, is his use of the term ruining? Dude, it has ruined it. It’s over.  Feel free to read the piece yourself but he also doesn’t even scratch the surface of how administrators have destroyed the practice of medicine.  They did this to control doctors.  They did this to give themselves more power and multiply.  And they won. Ruining?  Child, please.

Going back to the meeting years ago, I had exasperated the group so badly that one impish little doctor, who was the head medical director of us all, got up and screamed like a little boy, “What’s wrong with quality!?!” Talk about awkward.  It was loud, his face was red, he was shaking, and he was really mad.  It was almost like a five year old who felt someone didn’t like his finger painting.  It was so pitiful that everyone got quiet and there was an awkward silence that felt like an eternity.  I guess I was supposed to sit down but I thought, nope, I need to slap this dude’s ears back or make him take a nap, one or the other.  I once again put on my best Johnny Cochran imitation and began filibustering the meeting like a pro.  I reiterated all my points over and over until they had to call the meeting.  From that point on, the medical director wouldn’t even look at me.  I lasted another month, at best, before resigning from being a “physician leader”.  I never really spoke to the imp again and vice versa.  I wish I could now.  I would say, “Hey, Dr. Imp, what do you think is wrong with quality now? Dick.”

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] 

  2 comments for “What’s Wrong With Quality!?!

  1. Sir Hakum of Hugo
    February 29, 2016 at 8:37 am

    I am surprised that “medical director” didn’t start massaging his palms with a couple of ball bearings and muttering something about his missing strawberries.

  2. February 27, 2016 at 7:51 am

    When you let the twisted ‘define’ the terms, it goes badly.
    Anyone remember, “Truth? What is Truth?”

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