Tuesday, January 20, 2009
I was sent this article by a reader and I have to tell you, I see both sides of this argument. Have you heard? Dave Snow, CEO of MEDCO the largest pharmacy-benefits manager has stated emphatically
"I have no patience for a doctor who says, ‘I’m above it all, I don’t want to practice cookbook medicine"
He says this when doctors use the excuse that algorithms dumb medicine down and are only needed for PAs ans NPs.
Snow is pushing for pay for performance and uses physicians' lack of knowledge against them.
Recently MEDCO polled 1000 physicians about the CYP 2C9 genotype test approved by the FDA for Warfarin dosing.....guess how many knew about the test? 3....
Yes, that is correct......3 physicians. Do you see how this could infuriate someone who is not a doctor or who has trained in the system. As I doctor, I understand that medical school doesn't prepare you for genetics, I understand that Internal Medicine residency doesn't prepare you either.
So I have a much higher threshold to get pissed at people who have dedicated 12 years of their lives to study and learn how to care for human beings and get paid crap for it, unlike Mr. Snow or most corporate attorneys/accountants/hedgefunders.
However, even my patience does wear thin. Boy, imagine if you were paid an extra 100 dollars per patient that you know the genotypes and dose warfarin appropriately. Imagine if they actually taught about the VKORC1 variation in Asians versus African Americans and dose requirements......they don't even teach that in residency....
So, you want to fix the system? Punish the medical schools, not the doctors trying their best with what they were taught. If you want doctors to learn, pay for all of them to take 6 months off to learn genetics. Or pay them in a manner such that they don't have to see 20 patients a day or more to break even!
The system is broke, everyone is blaming each other, when the real problems lies in the system itself.
1) Doctors don't get paid the way they deserve, so to make the money they deserve, the system has turned into a volume NOT a quality system
2) Medical schools do not hire clinician teachers in genetics, therefore the PhD's teach this field. Inevitably boring medical students because the clinical translation is lost....assuming they actually teach genetics in medical schools less than 34 of the near 200 medical schools do.
3) Costs soar when you don't have the time to critically think and instead you use shotgun methods, which are less efficient than algorithms. But neither is true intelligence.
4) When we know patients' genomic make up we will be able to devise much more nuanced algorithms so Mr Snow is on to something, but........
What good is it when only 3 in 1000 doctors know about your algorithm?
5) Personalized Medicine is not coming without this education, therefore companies looking to profit from it, would be well served by teaching doctors....not trying to punish them...
The Sherpa Says: We need to stop blaming others in the system and work to fix the system. We will only get the whole story and solution by collaborating rather than punishing any side.....