Qualms, a new medical epidemic

The epidemic began in a nondescript conference room in a Washington, DC hotel. A small group of physicians and clinical experts were the origin of this menace. While the inoculum was small and the exposure limited, this disease promises to spread quickly.

I should have known better. Each time I am exposed, I have that same queasiness; just thinking about it makes me break out in a cold sweat. I try to avoid worrying. Fortunately, I am recovering, even as the epidemic inalterably spreads.

You might already be exhibiting signs of this plague: the bleary eyes, the woeful frown, the haggard look. You are a victim of qualms—or quality measurement stress.

Your first exposure probably came from an envelope marked “PRIVATE,” or during a lunchtime meeting—or, if you were truly unfortunate, from a local medical director. At first, there was disbelief, bargaining—all of the Kübler-Ross stages. Eventually, you try to live life as before. Another qualms victim.

As I sat at the technical assistance panel considering over 40 quality measures, just in the area of mental health, I knew I had fallen victim to qualms again. All was lost when I reluctantly voted to approve yet another accountability measure that recommended screening. How many hours would I have to spend with each patient just to implement these measures? I break into that cold sweat, my pulse races….

Sure, the efficacy evidence is persuasive. Who can argue that depression or alcohol misuse is not important to find or treat, or that patients with depression shouldn’t be evaluated for bipolar disorder or drug abuse. But I only have 15 minutes. And there is a waiting room full of patients. And they all have so many problems. I imagine the worse….

The group of psychiatrists and specialists is cordial. They empathize. But, see, here is the evidence. It can be done. You can screen for depression and problem drinking and these treatments are efficacious.

But you don’t understand. I don’t stop at depression—there’s diabetes, dyspepsia and diarrhea, colonoscopy, contraception and colposcopy, holding hands and healing hearts. You can’t expect more. Every specialist wants me to screen for their disease; every panel implores me to treat their syndromes. I am over-whelmed….

“Next Measure: percentage of patients diagnosed with a new episode of depression and treated with antidepressant medication who had at least 3 follow-up contacts….”

I truly have qualms.

The epidemic began in a nondescript conference room in a Washington, DC hotel. A small group of physicians and clinical experts were the origin of this menace. While the inoculum was small and the exposure limited, this disease promises to spread quickly.

I should have known better. Each time I am exposed, I have that same queasiness; just thinking about it makes me break out in a cold sweat. I try to avoid worrying. Fortunately, I am recovering, even as the epidemic inalterably spreads.

You might already be exhibiting signs of this plague: the bleary eyes, the woeful frown, the haggard look. You are a victim of qualms—or quality measurement stress.

Your first exposure probably came from an envelope marked “PRIVATE,” or during a lunchtime meeting—or, if you were truly unfortunate, from a local medical director. At first, there was disbelief, bargaining—all of the Kübler-Ross stages. Eventually, you try to live life as before. Another qualms victim.

As I sat at the technical assistance panel considering over 40 quality measures, just in the area of mental health, I knew I had fallen victim to qualms again. All was lost when I reluctantly voted to approve yet another accountability measure that recommended screening. How many hours would I have to spend with each patient just to implement these measures? I break into that cold sweat, my pulse races….

Sure, the efficacy evidence is persuasive. Who can argue that depression or alcohol misuse is not important to find or treat, or that patients with depression shouldn’t be evaluated for bipolar disorder or drug abuse. But I only have 15 minutes. And there is a waiting room full of patients. And they all have so many problems. I imagine the worse….

The group of psychiatrists and specialists is cordial. They empathize. But, see, here is the evidence. It can be done. You can screen for depression and problem drinking and these treatments are efficacious.

But you don’t understand. I don’t stop at depression—there’s diabetes, dyspepsia and diarrhea, colonoscopy, contraception and colposcopy, holding hands and healing hearts. You can’t expect more. Every specialist wants me to screen for their disease; every panel implores me to treat their syndromes. I am over-whelmed….

“Next Measure: percentage of patients diagnosed with a new episode of depression and treated with antidepressant medication who had at least 3 follow-up contacts….”

I truly have qualms.

The epidemic began in a nondescript conference room in a Washington, DC hotel. A small group of physicians and clinical experts were the origin of this menace. While the inoculum was small and the exposure limited, this disease promises to spread quickly.

I should have known better. Each time I am exposed, I have that same queasiness; just thinking about it makes me break out in a cold sweat. I try to avoid worrying. Fortunately, I am recovering, even as the epidemic inalterably spreads.

You might already be exhibiting signs of this plague: the bleary eyes, the woeful frown, the haggard look. You are a victim of qualms—or quality measurement stress.

Your first exposure probably came from an envelope marked “PRIVATE,” or during a lunchtime meeting—or, if you were truly unfortunate, from a local medical director. At first, there was disbelief, bargaining—all of the Kübler-Ross stages. Eventually, you try to live life as before. Another qualms victim.

As I sat at the technical assistance panel considering over 40 quality measures, just in the area of mental health, I knew I had fallen victim to qualms again. All was lost when I reluctantly voted to approve yet another accountability measure that recommended screening. How many hours would I have to spend with each patient just to implement these measures? I break into that cold sweat, my pulse races….

Sure, the efficacy evidence is persuasive. Who can argue that depression or alcohol misuse is not important to find or treat, or that patients with depression shouldn’t be evaluated for bipolar disorder or drug abuse. But I only have 15 minutes. And there is a waiting room full of patients. And they all have so many problems. I imagine the worse….

The group of psychiatrists and specialists is cordial. They empathize. But, see, here is the evidence. It can be done. You can screen for depression and problem drinking and these treatments are efficacious.

But you don’t understand. I don’t stop at depression—there’s diabetes, dyspepsia and diarrhea, colonoscopy, contraception and colposcopy, holding hands and healing hearts. You can’t expect more. Every specialist wants me to screen for their disease; every panel implores me to treat their syndromes. I am over-whelmed….

“Next Measure: percentage of patients diagnosed with a new episode of depression and treated with antidepressant medication who had at least 3 follow-up contacts….”

I truly have qualms.