One of the blogs I read (http://www.medrants.com/) periodically complains about performance measures especially, P4P (pay for performance) in medicine. He also says that we should focus on “safety” issues (such as central line infections) rather than performance over which often the physician has little control (such as a patient’s A1c values).
Now I can sympathize with this blogger in that I and others (including Jim Westgard) have objected without effect to CMS’s initiative to reduce the frequency of quality control in clinical laboratories. The logical arguments have failed.
But this blogger has also decided to try to address this issue by redefining terms. He wishes to ban the term “quality” from being used in medicine and this is one reason he uses the term “safety” for errors which the physician has control, such as central line infections. But redefining terms doesn’t work. If we use the word safety, there can be a safety effort with good or poor quality, so quality creeps right back into things. And many error rates can be measured which are not related to safety (patient harm) within the control of the physician and these too are quality.