Letters discuss board certification and electronic health records.
Board certification not predictor of quality care
I appreciate Dr. Christine Cassel's response ("Boards are not flawed" [Talk Back], October 22 issue) to my criticisms of the methodology of the boards ("Boards are flawed" [Talk Back], August 20 issue).
She is right to say that physicians' "knowledge and skills deteriorate over time." But many physicians tailor their knowledge base to accommodate to the needs of their individual practices and the availability of specialists in their communities who help them with difficult problems. This is not to shirk doctors' responsibilities to stay up-to-date. But I think she exaggerates the deterioration component and overlooks the fact that many doctors already take continuing medical education courses. And she overlooks the fact that it is almost impossible to practice poor medicine today because hospital peer review committees and the threat of malpractice force doctors to practice competently.
The article reported that among other characteristics, board certification resulted in only a 5.9% difference in "overall composite performance." The conclusion was that "individual physician characteristics are poor proxies for performance on clinical quality measures."
In a profession that increasingly is "hyper-regulated" and in an era that has made a fetish of quantification, it is important to remind ourselves that in pursuit of the "perfect," we can easily lose sight of the "good."
EDWARD J. VOLPINTESTA, MD
A better answer for EHRs still needed
Dr. Keith VanCuran asked for actual evidence that electronic health records (EHRs) are evidence-based ("Are the 'benefits' of EHRs evidence-based?" [Talk Back], October 8 issue). The response from Dr. Joseph Scherger cites the consensus report of the Institute of Medicine (IOM). This evidence is usually graded at level C or 3, depending on the system used, as it is expert opinion-based. The actual medicine we practice seeks higher standards of evidence that originate from randomized controlled trials (RCTs). Even then, the best RCTs may be suspect if the funding source for the study injects a bias. We need a better answer.
GERALD N. YORIOKA, MD
Mill Creek, Washington
EHR evidence too old
Dr. VanCuran asked Dr. Scherger to provide data that EHRs save lives. The "evidence" he provided was the decade-old IOM report, "To Err is Human," and former House Speaker Newt Gingrich's book. Neither provides any evidence that EHRs are the answer to the problem of medical error, a contention that has been seriously questioned.
When will the advocates of EHRs "put up [the data] or shut up?"
KEVIN KELLEHER, MD