Not a Health Care Soundbite

Jerome Groopman, Chief of Experimental Medicine at Beth Israel Deaconess Medical Center in Boston and author of How Doctors Think has an interesting article online at The New York Review of Books website about how medical "best practices" might be included in government health care legislation and how that inclusion might play out in the decisions of doctors and their patients. Groopman provides two viewpoints of how "best practices" might be legislated in health care reform, one that uses the established best practices as a "nudge" to get doctors to choose governmentally-approved health decisions, another that more aggressively promotes these "best practices" by providing financial incentives or negative consequences. President Obama's friend and advisor, Cass Sunstein, favors the first (providing doctors with some leeway not to choose always the established "best practice" method in dealing with a patient's health issue) and Peter Orszag, another of Obama's advisors and director of the Office of Management and Budget, prefers the more strong-armed approach:

Doctors and hospitals that follow "best practices," as defined by government-approved standards, are to receive more money and favorable public assessments. Those who deviate from federal standards would suffer financial loss and would be designated as providers of poor care. In contrast [to the Senate bill], the House bill has explicit language repudiating such coercive measures and protecting the autonomy of the decisions of doctors and patients.

I didn't know much about this debate until I read Groopman's article this afternoon, and I was fascinated by Groopman's discussion of how established "best practices" sometimes turn out to be wrong or not the best health choice for certain individuals. Thus, there are problems with aggressively pushing doctors to choose the "best practice" standard at all times in all situations. This situation reminds me of the debate over mandatory-sentencing laws.  When judges do not have any discretion over sentencing criminals, serious injustice sometimes results, for instance, first-time drug offenders given long jail sentences when they could have been put on parole, provided with rehabilitation, and given the opportunity to change the course of their lives (and thus not cluttering up the prison system and costing the taxpayers huge amounts of money).

What really struck me was the anecdote of Groopman's personal contribution to a "best practice" standard that proved to be wrong. You just got to listen to folks who are willing to admit their mistakes.

Anyway, it's a long article, published in another one of those magazines that some people sneer at for being "elitist," and thus won't be part of any health care soundbite--but it's worth reading: Jerome Groopman, "Health Care: Who Knows 'Best'?," The New York Review of Books, February 11, 2010 edition.