Stratification and standards: a quality assurance perspective

Article Abstract:

The way in which physicians practice medicine has changed extensively since 1965. As in previous years, many physicians are attracted to medicine by an interest in science and biology and for the satisfaction of providing an important service, but professional autonomy, financial security, and free choice of lifestyles is increasingly being determined by the government, insurance agencies, and other institutions. This is associated, in part, with consumer critiques of medicine, law suits, and dissatisfaction with the cost of health care. This article ascribes much that has happened to change the role of the physician to Medicare legislation, which has provided medical care for an increasingly greater number of Americans since 1965. Because of this act, the governmental costs of health care outstripped the costs for national defense in 1977, and is currently 11.4 percent of the gross national product. Due to this governmental participation in health care, increasing emphasis has been placed on accountability of the individuals and institutions providing health care, and this has also been termed quality assurance. The way in which physicians respond to the quality assurance process will determine the future nature of medical practice. Physicians should be the judge of the results of their activities and need to recapture their professional autonomy. The history of quality assurance efforts is reviewed, as are 10 reasons why physicians may resist quality assurance programs. The medical profession is increasingly being divided into a top level of administrators and judges of medical practice, who have little clinical experience, and a lower level of actual clinical practitioners. Some people have suggested that standards of care should not be developed by physicians. Physicians, consumers, administrators, financiers, and peer review organizations review quality assurance programs with differ goals and perspectives. Current quality assurance initiatives and increasing competition with for-profit interests provide a challenge to physicians to demonstrate that teaching hospitals and their medical staffs do indeed provide quality care; it is up to physicians to prove it. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medicine, Practice, Social policy, Medical care, Quality management, Medical care quality, Medical practice

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What is a good doctor? Patient perspective

Article Abstract:

A genetics researcher lists the qualities most patients value in their physician. Most patients want a caring physician who listens to them, is honest and takes time to explain things the patient does not understand. Communication is rated very highly by patients and they appreciate physicians who are available in person and over the phone. The most common patient complaints are long waiting times, rushed examinations, poor bedside manner, lack of accountability and complicated billing systems.

Evaluation, Beliefs, opinions and attitudes, Public opinion, Patients, Clinical competence

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