David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
It is already known that policies requiring emergency-only hemodialysis for undocumented immigrants are bad for patients (causing unnecessary suffering and higher mortality) and health systems (driving costs higher and causing inappropriate use of certain resources, such as emergency services).
This study shows that these policies are also bad for clinicians, whom they force to allow preventable suffering, provide suboptimal and unjust care, participate in extreme waste, and compromise their integrity.
The article effectively shows that clinicians find emergency-only hemodialysis policies to be unacceptable and that they suffer personally and professionally when they are forced to comply with them.
An editorialist notes that the ethical problems related to emergency-only hemodialysis would disappear in a system with universal health coverage and encourages physicians to advocate for that type of system while simultaneously leveraging existing resources to abolish perverse health policies.
The authors conclude that there is a significant association between maintenance of certification and fulfillment of these HEDIS measures.
However, an accompanying editorial notes that the presence of even small, unmeasured confounders could easily eliminate the significance of the difference between the groups. More important, the editorialist points out that the HEDIS measures examined in this study simply do not pass the sniff test as robust quality indicators.
This study does little to support the notion that the traditional system of maintenance of certification leads to provision of meaningful, higher-quality care.
The authors hypothesize that it may not be the EHR per se that is contributing to physician dissatisfaction. Rather, it may be the excessive regulations around documentation and billing in the U.S. that are driving physicians to spend more time with the computer and less time with the patient.
The authors suggest that regulatory reform may be a key element in the battle against physician burnout in the U.S.
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Wesorick DH, Chopra V. Annals for Hospitalists - 17 July 2018. Ann Intern Med. ;169:HO1. doi: 10.7326/AFHO201807170
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Published: Ann Intern Med. 2018;169(2):HO1.
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