Regional variations are created by "grand old men"

AMA Leader Commentary. By William G. Plested III, MD, May 3, 2004.

AMA LEADER COMMENTARY

A few words about current events in medical practice

SEE ARCHIVES

A message to all physicians from the chair of the AMA Board of Trustees, William G. Plested III, MD.

Today it seems like everyone is in a frenzy about the "quality" of medicine in the United States.

In large part this stems from the Institute of Medicine report "To Err is Human" that used decade-old data that were dubious at best. These data were then extrapolated to the nation as a whole, a ploy substantially beneath the dignity of a group that purports to stand at the pinnacle of our profession.

Yet this flawed report planted the idea that the nation's hospitals and physicians are responsible for almost 100,000 deaths a year due to medical errors.

It can be argued that the medical liability crisis is in significant part the sequel to this pitiful report.

The concern about the "quality" of medical care in America has led to an endless supply of self-styled experts ready to tell us how to practice our profession.

This "quality" debate is a huge subject and well beyond the scope of a single, simple essay. But there is one facet that has caused significant consternation among the pundits and critics, and that is the obvious presence of regional variations in the type of care that is recommended and delivered by physicians. This is one part of the quality debate that would appear to have its genesis and its potential solution squarely in our medical education system.

Basic medical school education in the United States is highly regulated and closely monitored. Curriculum requirements are generally standard, and the result is a product of high quality and surprising consistency. This quality, of course, depends upon a conscientious faculty that lives up to its dual responsibility of teaching and evaluating its students.

Lately, our medical schools seem to be interested in abdicating a portion of this basic responsibility by agreeing that the only way to evaluate students is for state medical boards to give a clinical skills exam using amateur actors who describe fake symptoms and signs. However, this is another issue, and I digress!