| Feasibility of measuring antibiotic prescribing |
‘Like I said, you’ll get patients who were seen within hours by two different people, and one gives the antibiotic and the other one doesn’t. It’s not necessarily that the person who doesn’t give it is always right, and the other one’s always wrong. It’s too subjective.’ – Chicago, paediatrician ‘There’s more thought process into the physician having to, there’s a reason basically why a physician chooses or not chooses to, the management specifically. So, until they actually come and look at our, the history, the physical, and overall clinical management, they really will not know why we prescribed the way we did it.’ – Los Angeles, family medicine/internal medicine physician |
| Belief that physicians will ‘game the system’ |
‘As soon as you start having measurements like that, you’re going to have a lot more diagnoses of walking pneumonia or pneumonia.’ – Los Angeles, family medicine/internal medicine physician ‘People don’t put down accurate diagnoses, and then when you have something like this, then everyone is going to start gaming the system. ‘I’m not going to put down diagnosis of bronchitis. No, I’m going to put sinusitis.’ Even through it’s bronchitis, I can give you the antibiotic and not get dinged for it.’ – Philadelphia, family medicine/internal medicine physician |
| Dissatisfaction with the quality measurement system |
‘These days we’re all getting measured on everything. Every time we click a button on the EMR (electronic medical record) whether it’s diabetes, cholesterol, blood pressure, antibiotic prescribing, no matter what it is someone’s measuring it. Someone’s telling us what we should be doing. I think, I’ll speak for myself; physicians are starting to get tired of being told what to do.’ – Philadelphia, family medicine/internal medicine physician ‘That’s going to fall into a P for P programme. A payment for performance which is the insurance company’s way of paying doctors less money.’ – Los Angeles, paediatrician ‘We’ve discovered that they don’t work very well, and then, almost always if there’s an incentive for doing something, there’s going to be a punishment for not doing it. There’s never just the incentive.’ – Birmingham, paediatrician |
| Distrust of tracking and reporting systems |
‘For example, I vaccinate every kid that comes to see me with Menactra(…)(Insurance company) recently said that I did not get 23 kids, but when I go to the state registry, every single one of those kids got their Menactra, before the age of 13. Their data collection practices are questionable and manipulable, and I don’t trust it.’ – Birmingham, paediatrician ‘The quality of the data seems always so poor(…)I have patients that I’ve never seen that are on my list, I had a patient that was dead for 2 years that was on my list. So the quality of the data collection and how you’re going to do that is so important.’ – Los Angeles, family medicine/internal medicine physician |
