Post Columns Debate Medical Practice: Data vs. Personality

Dueling Washington Post columns Sunday took opposing views – both critical - of the prevailing style of practice among today's physicians. Harlan Krumholz, a cardiologist and Yale professor, favors data-driven medical decision making, especially by patients. He hopes for a Consumer Reports-type source of detailed information for patients deciding which doctor to hire. Nephrologist Ronald J. Glasser laments the depersonalization of medical practice in an increasingly profit-driven industry.

Glasser points out that 93 percent of medical students graduating this year will end up working at "large clinics, managed-care companies or hospital systems." That trend in medicine has led doctors to abandon "the patient to the work rules of health plans and the professional demands of managed care" and replaced patient-physician relationships with "cookie-cutter best-practice guidelines and rules on prescribing drugs, acceptable lengths of hospital stays and the number of clinic patients a doctor must see per hour" (Glasser, 5/31).

By contrast, Krumholz argues, "For most patients, the decision of where to seek care comes down to a recommendation based on hearsay," rather than reliable information. "The paucity of information about medical performance not only makes it hard for patients to choose care. It also impairs our ability to improve care. If we in the medical profession could measure results, we could weed out bad practices and nurture the good ones" (Krumholz 5/31).

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