I did my undergraduate studies at Dartmouth College in Hanover, NH. The school’s Latin motto is “Vox Clamantis in Deserto”, which translates to “A voice shouting in the wilderness”. Its founding mission in 1769 was to “civilize” the Native American youth and, perhaps in a deconstructionist era, this sounds paternalist and demeaning.
In last month’s Thoracic Surgery News, it was reported that with the recent update of Physicians Compare, the Centers for Medicare & Medicaid Services has for the first time posted individual performance scores for the 40,000 professionals who are part of the system. This system is supposed to provide guidance and transparency for patients when seeking to make choices for obtaining medical care. However, soon the “voxes” of the physician establishment started “clamantisizing”.
AMA president Steven Stack decried the widespread inaccuracies of the 2014 calculation due to acknowledged process difficulties by the Centers and thus consumers visiting the website were likely to get the false impression as to the quality performance of the participating physicians. Dr. Wanda Filer, president of the American Academy of Family Physicians, commented that performance scores are displayed as stars each representing a 20th percentile. She argues that a 1-5 star rating system is too simplistic to provide informed decision making, lacks discriminatory vetting of listed doctors, does not reflect the complexities of providing clinical care and is, flatly, childishly ill-conceived. Moreover, there is no feedback to physicians to allow self-improvement before the next metric cycle is posted, nor are there educational mechanisms to allow doctors to improve accuracy of self-reporting. Their bad grade may be a reporting glitch, not poor medical practice. A prominent healthcare attorney, Karl Thallner, raises the issue of physicians who do not participate and lack of uniformity the way participating physicians report data, again invalidating the credulity of the website assessment.
All this outrage seems constructive. There is no vitriolic renunciation of the concept, no defamation of character, no demand for repeal, and none of the ‘Obamacare doomsday’ rhetoric. It is a reasoned appeal to fix the process and allow physicians to participate so that a good concept can work better for the public’s benefit… but they are talking at Federal bureaucracy. Now do you have a better concept of what “Vox Clamantis in Deserto” means?
By Norman Silverman, MD, with Ryan McKennon, DO and Ren Carlton