Dear Doctor, (letter to a Doctor)

Physician reviewing records

This is a post from a person I interact with on social media. It has been heavily modified to keep anonymity. I have obtained express consent from this person to share their views here.

Dear Dr. — Thanks for seeing my child today & conducting a comprehensive exam. We were pleased with your care & the recommendations received.

However, please work with your staff on:
1 -Don’t tell me ‘1 hour’ if I ask how long the the appointment will last and then expect me to be happy after more than three.   Yes – I do know I will have to wait  – a range would be helpful.
2 – When called to reconfirm by your staff, I asked if they had all of our reports sent 2 months ago which were printed for you (it’s a little complicated).   Don’t have them tell me ‘yes’ when the answer was ‘NO’.   Putting a ‘see me’ post it note on the file from a staff member who is out of the office is not helpful.
3 – You are excellent in what you do.  I’m happy to pay for your knowledge and expertise but not your data entry skills (see above).
4 – When I explain to your staff that my child is uncomfortable going to physician’s offices and I need to prepare him about what to expect, please don’t giggle.  Is this the first time your staff has been asked this question?  I can’t believe that.

Thank you.

 

Comments:

-A friend once sent a bill to his doctor for making him wait 3 hours.

-I hear you . Waiting forever is the worst! Some health professionals need to brush up on their interpersonal skills.

-(We) were just talking about the medical practitioners we’ve left over the years…because of their staff!!

-…staff was really frustrating.  …tried to give feedback constructively and professionally but the attitude was unreal.

 

Can anyone not relate to this?  (Unless you are a practicing physician or administrator and you are so busy you have no time to go to the doctor!)  I view this as a systems failure.  The processes to make sure that this patient had an excellent experience were not there – the Doctor seems to being doing all he can to make the experience great (except for the ubiquitous data-entry EMR curse that patients hate as much as physicians!), but the staff undermines his efforts and this visit goes squarely into the negative category.  Regardless of where you want to place accountability (the staff, the physician, the office manager, the administrator), the root cause of this negative experience could be looked at and improved.

What the patient (patient’s parent/responsible party) wanted in this circumstance was:

  1. Accurate scheduling (responsible booking, integration with MD’s calendar)
  2. Accurate information (saying “you should block off your afternoon, but we will try to get you out in an hour” would go a long way here)
  3. No data entry (hire a scribe or switch your EMR system!)
  4. Transmissible Review of information by a staff member (no “see me” post-its – that’s poor continuity of care)
  5. To be treated with respect and dignity (NO giggling or attitude).

The last item is the most concerning – I know that we are starting to recognize ‘compassion fatigue’ and ‘burnout’ in docs in increasing numbers, and it almost certainly crosses over to support staff.  But this offending staff needs to be trained/educated, or shown the door.  Someone else’s discomfort is never a cause for a healthcare staffer’s entertainment.  Better to create systems and processes that rein in the chaos and allow these staffers to feel less besieged and give a level of care that supports the hard-working doctor’s efforts, not negates them.

 

The Measure is the Metric

There is a maxim in management circles to use data-rich methods of management.  Peter Drucker is reputed to have said, “What gets measured gets managed.” Clearly better than managing by the hem of one’s skirt (or seat of one’s pants), data-driven management allows for assessment of measured items.
It is interesting to consider the perturbations of this statement:
-if it can be measured, it can be managed (implying causality)
-if it can’t be measured, it can’t be managed (negative causality)
-if it can’t be measured, it doesn’t matter (reductio ad absurbum)
You can pick for yourself where in the spectrum you lie, and how far from Drucker’s original statement you are.
 
But there is another issue in measurement that isn’t as well addressed – the influence that the measure itself has on what is being measured.   This is what is known as an observer effect in Physics – simply measuring perturbs the system.  The Heisenberg uncertainty principal has been cited like this (that’s actually NOT what the Heisenberg says, but that’s beyond the scope of this discussion).
 
So, let’s acknowledge that observation, or measurement changes what is being measured itself.  An observation, or ‘measure’ of X (insert variable here – productivity, speed, outcome, etc..) is performed.  It is compared to a standard, or ‘metric’ is performed.
 
For a process or an person, there may or may not be established standards of measurement.  Therefore, a baseline or initial measurement becomes the metric to compare future measurements against.  As process improvement or skill improvement happens (hopefully), subsequent metrics should improve in both accuracy and value.
 
Let’s consider a human measure and its associated metric.  A manager may wish to evaluate his employees by comparing their productivity to an established range of productivity.  The employee is being measured, and is being compared to a metric.
 
But employees aren’t stupid.   Even if they have not been told that they are being measured, when they see the difference in their performance reviews as compared to their peer’s performance reviews, they figure it out.  And those employees with performance reviews that didn’t sit right with them become more diligent in their work, to achieve a better performance review next time.  Some employees will even figure out that they are being evaluated, and up their game before the performance review.

 

Positive feedback loop for the measure is the metric post.
Positive feedback loop in a simple system

So, by the mere act of being measured, we change what is being measured.  The measure is the metric.

And it shouldn’t be too hard to figure out that WHAT you measure and WHAT you choose to be the metric are more important than you think.