Getting Doctors to Listen: Ethics and Outcomes Data in Context

By Philip J. Boyle | Go to book overview

DONALD J. MURPHY


Guideline Glitches: Measurements,
Money, and Malpractice

Expectations for outcomes data and resulting practice guidelines are high for many health care professionals. I, too, share enthusiasm for the critical analysis (i.e., outcomes research and guideline development) that has emerged over the last two decades, but I also have doubts about the promises of this movement.

From a clinician's perspective, I will focus on the practical obstacles to guidelines' reaching their potential. I choose guidelines because their recommendations for action are unequivocal. If guidelines are to enhance health care yet control costs, professionals and outcomes researchers must overcome most of these obstacles. Obstacles can be eliminated, but it won't be easy.

Many factors influence physicians' compliance with guidelines. These include their attitudes about utilization review, 1 government regulation, 2 physician profiling, 3 uncertainty, 4 private industry, 5 clinical autonomy, 6 sponsors of the guidelines, 7 necessity and appropriateness of care, 8 opinion leaders, 9 conflict in guidelines, 10 and the value of guidelines in general. 11 Patients' expectations 12 and the sociocultural milieu are other important factors. 13 No doubt many more factors exist that have not been studied.

This chapter focuses on three other factors that are frequently operative from a clinician's perspective. Investigators and clinicians are well aware of two of these factors, money and malpractice. 14 At some level, many physicians think about money and malpractice every day. The third factor, measurements, is not so obvious. A case study helps illustrate these three factors.


Case Study

Mrs. Hart is an eighty-five-year-old with diabetes, a history of breast cancer, and advanced coronary artery disease. She had an angioplasty in 1990. Her angina and shortness of breath were stable until September 1994, when these symptoms accelerated despite near maximal medical therapy. The attending physician referred Mrs. Hart to a cardiologist to see if she needed another angioplasty. The cardiologist interviewed and examined Mrs. Hart, did an

-100-

Notes for this page

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this book

This book has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this book

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this page

Cited page

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited page

Bookmark this page
Getting Doctors to Listen: Ethics and Outcomes Data in Context
Table of contents

Table of contents

Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this book

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen
/ 234

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.