“Hospitals Prescribe Big Data to Track Doctors at Work,” a July 12, 2013, article in The Wall Street Journal, describes a California health system that monitors physicians and grades them on the basis of what percentage of their patients meet certain metrics, such as a blood glucose level (as measured by HbA1C) of less than 8 percent.
But if some diabetes patients refuse to come in for visits, physicians can’t track their progress. If their blood sugar is elevated when they do come in, the measurement system gives the physician a black mark.
Dr. Keith Lee has found a solution to this problem. He refuses to give such patients long-term prescriptions. This forces them to come in for checkups in order to get new prescriptions. “I cut them short, and then they get the message,” he reportedly said.
This isn’t a case in which drug dispensing is tightly limited because the drug treatment has significant risks and requires higher than normal expertise to dispense safely. Nor is it a case in which a rude or abusive patient is impossible to deal with or threatening a physician with bodily harm. Judging from his reported statement, Dr. Lee is willing to use his prescribing power simply to make his patients visit on a regular basis so that he has a better chance of meeting his employer’s goals. Is treating patients this way in accord with the ethics of the medical profession as they have been traditionally understood?
Does your answer remain the same if it takes many hours for a patient to make a visit or if the patient has to miss large amounts of work? Does it change if the physician was refusing to treat a child unless his parents ensured that he had all recommended immunizations? What about a hospital refusing hip replacement surgery to an anti-abortion protestor?
A1C levels are known to vary with ethnicity, age, and alcohol consumption. There is some evidence that tight management of glucose control targets in people who have high A1C is associated with higher mortality risk, more hypoglycemia and slightly higher risk of adverse events.