Re: c/s rate and midwives
From: art fougner, md (evsono@pipeline.com)
Wed Mar 7 09:25:33 2001
the US has this infatuation with numbers - cpt codes, sat scores,
biophysical profiles scores, etc. to reduce all the vicissitudes of
life to a number seems a pity.
art
just my opinion, i could be wrong.
At Wed, 7 Mar 2001, Efrain Ramirez wrote:
>
>Let us first admit that no one knows what the ideal C/S rate should be -
>having said that, it is useless to judge a % or a rate in an individual
>- there are flags-of course- but to "judge" one must take each and every
>case for evaluation - a rate is only an indicator - not a "grade" of
>your practice - outcomes - neonatal and maternal - should be evaluated
>and counted in the overall "score".. my dos centavos...
>
>At Wed, 7 Mar 2001, DoctorJoe@aol.com wrote:
>>
>>In a message dated 3/6/01 9:54:17 PM, wagedj@bellsouth.net writes:
>>
>><< . not only is this unfair but it begs the
>>
>>> real question - again, why is section rate an outcome measure?
>>
>>> art
>>
>>I agree. My patients get officially admitted under my covering physicians
>>
>>and then we have to go in and separate the numbers in order to get accurate
>>
>>reports. But there is no way that my numbers should be bundled into theirs.
>>
>>In our collaborative relationship, my section rate reflects *my* patient
>>
>>population and my management style/technique/expertise..........not theirs.
>>
>>Even labor and delivery nurses have 'section rates' and reflect another
>>
>>piece of the whole......maybe a very large piece in some situations.
>>
>> >>
>>
>>In real peer-review or quality assurance parlance, the c-section rate would
>>only be an indicator or a "pattern". If someone's c-section rate were, on
>>routine surveillance, out of step with the rest of the organization (or
>>organisation, for some of you), then a case sampling would be in order, to se
>>e if each case were within the standard of care. If there were obvious
>>medical explanation for the variance in pattern (like lots of multiples or
>>whatever), then the explanation would satisfy the examiner and the question
>>solved.
>>
>>IF, on the other hand, the peer-review were being done by competitors, there
>>would be NO case by case analysis looking for an explanation. The difference
>>in rate BY ITESELF would be "evidence" of substandard care and the
>>practitioner would be hanged or shot.
>>
>>Joe P.
>>
>>Don't want to seem to be belaboring (or belabouring) the point, but that's
>>the real world...
>
>--
>"Life is neither the notes nor the silence between the notes, but the music that
> arises out of sound and silence felt as a living whole. Stop choosing...between
> chaos and order, and live at the boundary between them, where rest and action
> move together..." David Whyte
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
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