Comparative Effectiveness Research–The View from Wachter’s World

Bob Wachter discusses the challenges of implementing the comparative effectiveness research results we have in hand. From the perspective of leading physicians and frequent contacts with a diverse range of specialists and sub-specialists in my tertiary care providing community, teaching hospital I find myself nodding in agreement with Wachter's observations.

Everyone but the citizen's ox gets gored by comparative effectiveness research implementations. I use the term citizen advisedly, taking my cue from Obama; for some number of patients may well feel that they lose out as individuals, even as the polity benefits.

Tough implementation ahead with lots of squabbling before we're done accomplishing a fraction of the result the policymakers are seeking.

Customer-Consumer Confusion and now Patients, too

EP Monthly's "WhiteCoat's Call Room" posts two links and discusses "Patients or Customers"?

Patient, customer and consumer have specific meanings, not accurately used in the posts from Aggravated DocSurg and Detroit Receiving's EM Blog.While I'm in general agreement with many (not all) of the sentiments expressed in the two posts, it's important to get the correct meaning of the terms.

Customer= he who pays
Consumer= he who uses

The definitions are from Princeton Wordnet, but they're the same as what I was taught at Wharton 20+ years ago.

Part of our challenge in forming relationships in the ostensible business (good or service exchanged for value) is that for many users of physician services (i.e., patients) both the patient and physician experience customer-consumer confusion with consequent misalignment of incentives.

Patients will be increasingly demanding of receiving value in their care for value given directly (fee-for-service) or through employer and tax-based services. They will find the employers holding them accountable for "smart shopping" or the government steering in other ways–or both.

My father was a proud physician, he cared only for patients. Were I to view the world as he did, I would be struggling to feed my family. In this year of the 200th anniversary of Charles Darwin's birth, let's remember that it is not only individuals, but also entire species and perhaps professions for whom survival is not guaranteed; one must adapt or die.