Physician Worth

Last week I had my physician evaluation, the first one since starting my current position at my hospital five years ago. I sat across from my medical director, he opened up my file, took out several short stacks of papers, and slid them across the table one by one so that I could see how I measured up. The first set of papers showed what my patient satisfaction scores were, based upon the mere twenty-two patients that had responded to the phone call from the company that monitors our patient feedback. Patient satisfaction scores have been around for decades, with the lofty goal of improving the delivery of care to patients, as well as to determine physician and staff bonuses. I glanced at my numbers, noticing that all categories were in the red (bad) except for one which was yellow (middle ground), with none in the green (good) category. I was curious about this, not because I think I’m a perfect physician, but because I believe I do a good job of taking care of my patients. My medical director explained that the only scores that counted as acceptable scores were 9 or 10 (out of 10), which is why most of mine were in the red. These measurements put pressure on physicians to do what their patients want (like order a test or prescribe a medication that really isn’t indicated), so they will be liked by their patients, who then will be more likely to respond positively to the patient satisfaction questions.

The next set of papers showed all the outcome statistics of my stroke patients that had completed their rehabilitation at our hospital. How many days they were at the rehabilitation hospital (length of stay), how many were discharged back to the acute hospital for being too sick to stay at rehab (acute transfers), and then, how many of my patients did not discharge home but to a skilled nursing facility. This data is meant to show how good a job we had done in taking care of these stroke patients. The goal for a “great” rehabilitation hospital is to have 80% of the patients discharge home, not back to the acute hospital or to a nursing facility. It does not matter if the patient really needs to return to acute, or if they don’t make enough functional progress to go home, or if their family backs out of the commitment to take their loved one home. These are things beyond my direct control, are multi-factorial, and yet, are also considered accurate measurements of my success as a rehabilitation physician.

Additional data points used in my evaluation are the meaningful use criteria that I am expected to complete in order to get a certain percentage of bonus pay. These are criteria designed by CMS (Centers for Medicare & Medicaid Services) for electronic health records that when met, allows a hospital to get incentive payments. Of course, they are meant to “improve health care quality, efficiency, and patient safety.” But for busy physicians like myself, they end up being more boxes to click, more time on the computer instead of time spent with the patient.

It isn’t that patient satisfaction scores, patient outcome statistics, and meaningful use criteria aren’t in their own way valuable in objectively trying to understand the quality of healthcare provided by any physician or hospital system. The problem is that they are inherently flawed at capturing the true essence of healthcare delivery; they imperfectly capture what is difficult to measure and often are even inaccurate. And yet, my worth as a physician is partially dependent upon this data.

What if?

What if there was a way to measure the subjective experience of our patients? We do get comments passed on to us when a patient mentions us in their patient satisfaction phone calls, but these were not part of my evaluation. What if we could measure how much heart and love a physician puts into their practice? Or measure the average length of time before a physician interrupts their patients, with bonuses for longer time frames? What if we could measure how much silence occurs during an office or hospital visit, silence to give the patient time to say what’s really on his/her mind? Or we could measure the unexpected tears that drop when the patient feels seen, really seen, for the first time? What if we could measure how many times patients tell me they wish I could be their primary care physician, not because I am perfect, not because I have all the answers, but because I create a safe space for my patients to tell me the truth? What if we could measure all the times a patient’s resistance to accepting a certain course of treatment melts away, not because of pressure from a physician, but because the doctor-patient therapeutic relationship was able to uncover the real reason behind the resistance? What if we could measure how often our physicians are present, really present, with their patients, not distracted or typing in the computer at the same time in order to be efficient?

What if?

What I know deep in my bones is that my worth as a physician is not measured by data and statistics. My worth is measured by how much joy I feel at work, by how collaborative I am with my co-workers, and by how often my patients shift their thinking about themselves and their disease process.