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President's Page
February 2007
Knowledge is Power:
Medication Safety Initiative, Electronic Medical Records, and BCBS BlueCompare
2007 DCMS President“Knowledge is power.” This is an old saying, but we physicians make use of this axiom every day. We continually use information provided by diagnostic tests, clinical exams, and research to gain power over disease and ailments, and to save and improve the quality of our patients’ lives. We have trained for years to understand this medical knowledge and to respect the power it provides.
Sometimes just a small amount of knowledge can provide tremendous power. An example of this is a patient medication list. How many times have those of us in direct patient care breathed a sigh of relief when our patient pulls out an up-to-date and complete medication record? How many times have we wished for such a list when our patient tells us, “I take a blue pill, a water pill and, oh yeah, one of those hormone pills”?
On page 54 in this publication, you can read how the Dallas County Medical Society, together with the Tarrant County Medical Society and the Dallas-Fort Worth Hospital Council, planned the DFW Medication Safety Project, “Educate Before You Medicate.” This project is a month-long blitz by physicians, hospitals, pharmacies, and health plans to educate patients about the importance of carrying an up-to-date medication list. The article tells patients how to obtain a list of their medications, and how to organize and create their own list. Please read the article to get all of the details. This is a “low-tech” method for obtaining medical knowledge that will empower both physicians and patients to provide more accurate and prompt medical care, especially in emergencies. This will reduce the risk of inadvertent medical errors.
Knowledge provides power, but the misuse of medical knowledge can give aberrant power. The potential for such misuse grows with the increased portability and availability of information resulting from electronic medical records (EMR). In his December President’s Page, Dr David Bookout discussed the need for privacy protections to prevent the exploitation of patients. Taking that one step further, consider how information that is “private” can be misused. Recently, The Dallas Morning News reported on the increasing incidences of discrimination against individuals with diabetes. The News cited a UPS service truck mechanic with an unblemished work record who was taken off the job for fear that his diabetes might cause him to pass out while driving. This is not a privacy issue. Rather, it is an example of misapplied medical knowledge and the distorted power it can give, however well intended. Nonmedical decision makers should work with healthcare providers to better understand the difference between type I and type II diabetes, including current treatment and monitoring methods, and stop relying on myths regarding diabetes. These employers have access to medical knowledge but may not understand how to use it. Access to medical knowledge does not guarantee that knowledge will be used appropriately.
Another example of misapplication of medical information involves the recent and fortunately aborted roll-out of BlueCompare. Most of us received our letters describing how we were assigned a dark blue ribbon, light blue ribbon, or gray ribbon in the Blue Cross Blue Shield of Texas’ BlueCompare program. This program, which had been scheduled to start in January 2007, was touted as a way for patients to identify “quality” physicians. The ratings were based on claims data; no medical records were requested or examined. Physicians had no opportunity to provide input through surveys or questionnaires. The data was not validated. Again, this is a misuse, or at best, a misunderstanding, of medical knowledge that carried with it the potential to give Blue Cross unwarranted power over physicians.
So, here is my point, in the form of a question: What component in a patient’s list of medications provides the power to treat disease, but is missing from a corporate decision to alter a diabetic person’s work duties and from an insurance company’s haphazard attempt at quality assessment?
The missing component is the physician.
Physicians are trained to study and understand medical information and the power it gives us. I did not train to run Blue Cross and I did not train to run UPS. By the same token, Blue Cross and UPS executives did not train to understand and interpret medical information. We as physicians must be vigilant about the misuse of medical knowledge, for it easily can lead to a misuse of power, especially when financial motives are involved. I was glad to see physicians take issue with Blue Cross and to see the resulting changes to the BlueCompare. Other health plans, employers, and agencies will misuse medical information and knowledge in an attempt to achieve their goals. I hope that we as the medical knowledge experts, will guide them through this process to the goal of quality and compassionate care.
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