Reporters often get it wrong, too

Nancy Valko forwarded a New York Times article, that irritated me as a doctor, on several levels.
First, there's no such thing as a "flesh eating virus." Most likely Isabel's secondary infection was a bacteria: Group A Streptococcus.

The fact that 20% are found to be "misdiagnosed" at autopsy does not mean that a correct diagnose is possible without the autopsy.
I would like to note that the doctors made the correct diagnosis in each of Mr. Leonhardt's pediatric cases. One child was cured while the other, tragically, was not.

I can assure you that doctors are self-driven to care for patients and to excel at what we do. If it weren't for our internal drive, I don't think any doctor would take Medicare or Medicaid. But articles like this remind me that no one wants to work for less than the cost of office overhead to see the patient and no respect or appreciation. In my opinion, much of "burnout" in medicine (and probably in most other occupations) is the combination of working for low pay and low respect.
(As a family doctor, I could handle never being as well paid as superspecialists [or the mythical "rich doctor" so many still believe in], but I can't handle the assumption of "fraudandabuse." I want to be the good girl, if not the hero.)

We doctors are fallible because we deal with living patients and what sometimes seems to be an endless variety of expression of disease. Thank goodness for new tools like the database from Isabel. We all buy new books, subscribe to horribly expensive journals and earn continuing medical education credits. We cannot autopsy our patients and we cannot see the future. We certainly don't know the results before we order those tests so they may turn out to be unnecessary. We may diagnose leukemia without immediately recognizing the particular unusual form which is not susceptible to chemotherapy. As in the case of Isabel, the early symptoms of a secondary bacterial infection may be masked by the symptoms of chicken pox just as the child's immune system is unable to resist certain types of bacterial infection. The viral or bacterial count may be too low to culture or "mixed."


Pay for Performance (P4P or "Pay for Play," as some of us call it) as it has been designed up to this time is not specific for improvement in the health of patients or even to reward or discern better doctors. While guidelines help doctors know what scale we will be measured by and give us a goal, all that's being measured so far are systems changes, not physician improvement. The goal of the P4P initiatives is "management," or to save money. The Center for Medicare and Medicaid pilot projects are aimed at hospitals and large group practices of greater than 200 doctors and rewards "efficiency" in lowering patient's glucose or cholesterol levels. Which will put doctors under pressure to "fire" patients who do no keep appointments or exercise hard enough. (Good bye smokers!)It will not reward listening to patients, holding hands, professionalism or bedside manner. Large practices with the ability to cash in on economy of scale will benefit for doing what they already do. Nothing that I've read about P4P leads me to believe that Medicare plans to pay better doctors more money.