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- May 25, 2011
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Recent EM periodical had a section by Dr. A. Katz and I think the this section in the May edition is worth a little discussion.
This piece informs us that pain medication is, in fact, not the driver of patient satisfaction scores.
I would agree. And I think we all know this, as far as an overall driver of these scores goes.
But that is NOT what is important about these scores. It is not what individuals who are bonused and/or paid on these scores care about.
I think from what I know from previous practice (currently do not get any pay or bonus from them) and talking with guys/gals is the thought on liberal pain med prescribing is a fear of that ONE BAD SCORE. Why? Because, like a credit report, one horrible score can ruin your percentile ranking m for a long time...until you can flood it out. And this can mean less $$$ and sometimes more scrutiny from higher ups (a hospital employee gig I moonlight with has their employee docs getting letters every time they get a 3 or lower on PG).
There is also a HUGE experiential conflict with this. I used to work for a group that enabled us to view all of our PGs and I would regularly have written comments from patients to the effect of my pain control (I do not liberally Rx opioids) This ran from only giving a Rx and no shot/IV/something stronger, to complaints about the # of opioids Rx, and a couple of my favorites were actually commentary that chastised me for trying to talk to them about "their" pain and how pompous it is for a doctor to tell the patient what should work for their pain. These were exclusively from non Fx, non CA, benign exam pts BTW. A lot were dental and MS strain.
My problem was not getting high scores. My scores were awesomeness vast majority of the time. 4/5-5/5.bBut that does not matter. All it takes is one, unless you have a ridiculous n, and all your praise and thoughtful doctoring gets reduced to you are on the 80th percentile on PG....No Soup For You this month!
However...even getting a good amount of 4/5 (which is pretty damn good), can screw you out of the top percentile as we know.
If you where graded as simply as your overall trend this would not be a problem. But as it is, guys/gals are trying to save against that one bad score!
Does this work? Who knows, maybe not.
Why does this need to be a contest against our peers instead of each individual's long term trend?
PG doesn't care about outliers, does not allow any longer the "do not send survey" option, and when you score folks on percentiles it is not going to be any real use to those that actually give the care, take the time, and take the risk every day.
But, that isn't what it is about anyway.
I see articles like this as either academia fantasy BS and/or CMG propaganda/brainwashing.
Also...with many EMRs we can see a LOT more than previous and I know it will vary with location/EMR , but I can see exactly what was Rx on any previous visit (when reviewing previous visits for an acute visit). And even with the partners that talk a good game about not Rx'ing opioids, etc...
I see a LOT, LOT, LOT, of opioids/z packs/abx and with much more frequency and more #s/Rx than I would have thought! :
Thumb-typed from iPhone.
This piece informs us that pain medication is, in fact, not the driver of patient satisfaction scores.
I would agree. And I think we all know this, as far as an overall driver of these scores goes.
But that is NOT what is important about these scores. It is not what individuals who are bonused and/or paid on these scores care about.
I think from what I know from previous practice (currently do not get any pay or bonus from them) and talking with guys/gals is the thought on liberal pain med prescribing is a fear of that ONE BAD SCORE. Why? Because, like a credit report, one horrible score can ruin your percentile ranking m for a long time...until you can flood it out. And this can mean less $$$ and sometimes more scrutiny from higher ups (a hospital employee gig I moonlight with has their employee docs getting letters every time they get a 3 or lower on PG).
There is also a HUGE experiential conflict with this. I used to work for a group that enabled us to view all of our PGs and I would regularly have written comments from patients to the effect of my pain control (I do not liberally Rx opioids) This ran from only giving a Rx and no shot/IV/something stronger, to complaints about the # of opioids Rx, and a couple of my favorites were actually commentary that chastised me for trying to talk to them about "their" pain and how pompous it is for a doctor to tell the patient what should work for their pain. These were exclusively from non Fx, non CA, benign exam pts BTW. A lot were dental and MS strain.
My problem was not getting high scores. My scores were awesomeness vast majority of the time. 4/5-5/5.bBut that does not matter. All it takes is one, unless you have a ridiculous n, and all your praise and thoughtful doctoring gets reduced to you are on the 80th percentile on PG....No Soup For You this month!
However...even getting a good amount of 4/5 (which is pretty damn good), can screw you out of the top percentile as we know.
If you where graded as simply as your overall trend this would not be a problem. But as it is, guys/gals are trying to save against that one bad score!
Does this work? Who knows, maybe not.
Why does this need to be a contest against our peers instead of each individual's long term trend?
PG doesn't care about outliers, does not allow any longer the "do not send survey" option, and when you score folks on percentiles it is not going to be any real use to those that actually give the care, take the time, and take the risk every day.
But, that isn't what it is about anyway.
I see articles like this as either academia fantasy BS and/or CMG propaganda/brainwashing.
Also...with many EMRs we can see a LOT more than previous and I know it will vary with location/EMR , but I can see exactly what was Rx on any previous visit (when reviewing previous visits for an acute visit). And even with the partners that talk a good game about not Rx'ing opioids, etc...
I see a LOT, LOT, LOT, of opioids/z packs/abx and with much more frequency and more #s/Rx than I would have thought! :
Thumb-typed from iPhone.