The sicker the better?

Found this interesting piece on MedPage Today (For Patients with Many Chronic Problems, More Care Is Better Care):

The higher the number of chronic medical problems patients have, the better the quality of their healthcare tends to be.

The findings suggest that physicians who care for patients with a raft of long-standing problems needn’t worry that they might be penalized by quality-of-care watchdogs an international team of investigators wrote in the June 14 issue of the New England Journal of Medicine.

I don’t have NEJM access so I don’t know exactly what the article says –and may be interpreting it wrong. Nevertheless, it triggered a couple of thoughts:

  • First, it’s an interesting view into the physician mindset and the state of quality measurement and performance incentives today.  The article seeks to reassure docs that they won’t be penalized for taking care of patients who most need their help. I’m glad the answer came out as it did
  • Second, you’d think patients with multiple conditions would be harder to take care of. Their needs are complex, so coordination must be a problem. Everyone talks about it –and it was the impetus behind the failed Medicare Chronic Care Improvement pilots

On the second point, though, I’m actually not totally surprised. In my experience, physicians like to take care of people who have serious illnesses, as long as they’re not completely hopeless. The less seriously ill may just not get as much attention.

This may be tangential, but it reminds me of when my grandfather was in a top teaching hospital many years ago. He had a variety of old man afflictions, but his case wasn’t all that interesting and there weren’t many doctors looking in on him. A relative, who was in med school at the time, got my grandfather some extra attention from the top specialists by pointing out some interesting and perplexing symptoms. His theory at the time was that if he could highlight my grandfather as a potential case study (for the NEJM perhaps?) it would benefit his care. I know it’s not exactly the same as today’s article, but maybe there’s some relationship.

June 15, 2007

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