Clinical Assessment: Clinical or Political Decision?
Each area of specialty has its own problems in patient assessment. For example, in geriatrics, a comprehensive strategy must be implemented to delay the development of disability and reduce permanent nursing home stays among incapacitated or elderly people living at home. A recent study substantiates that an aggressive rehabilitation program to detect and modify biologic, psychological, social and environmental risk factors for disability may reduce the number of nursing home and hospital admissions (See:
- Stuck, A et al. A Trial Of Annual In-Home Comprehensive Geriatric Assessments For Elderly People Living In The Community. N. Engl J Med 1995;333:1184---9
- Ferrucci L. et al. Progressive versus catastrophic disability: a
longitudinal view of the disablement process. J. GERONTOLOGY.
1996;51A:M123-130
- Luigi F. et al. Hospital diagnosis, medicare charges, and nursing home admissions in the year when older persons become seriously disabled.
JAMA. 1997;227:728-734)
However, assessment involves diagnosis. A proper diagnosis always guides a rational treatment. Dr. Keys goes beyond disease labeling. The question in diagnosis is whether or not diagnosis in this patient is done primarily to
- trigger a reimbursement code
- satisfy a director or administrator of managed care
- comply suitably with applicable clinical practice guidelines
- protect against malpractice issues by playing it safe
making the diagnosis of this patient fundamentally grounded in....
- the cement of mediocrity
- medical/institutional politics & malpractice fear issues
- institutional consensus (safety in numbers)
- concerns of insurance reimbursement
True diagnosis should be a clinical decision purely in the best interests of a patient and not mainly an administrative act or determination. We know what Dr. Keys does---what is your doctor or clinic doing?
Contact Dr. Ronald B. Keys at (718) 460-3966 or e-mail at rkeysphd@brainlink.com.
After all, it's only your life.