You Stink

[AF M4]

Yes you do. Or at most, you're barely adequate:

http://www.military.com/features/0,15240,181737,00.html?wh=news

So here's the thing. I work for a great group of people, but there's no way that all of my "customers" are going to be "completely satisfied" when they fill out their surveys, which in turn play a large role in how I and physicians in general are judged in our performances. (RVUs, of course, also play a big role.)

The problem is, I don't have "customers". I have patients. When you're serving a customer, the customer is always right. When you're serving patients, it's a different story. Again, most people are great. But there's always going to be that part of the population who aren't going to be happy unless I put a gumball machine full of Percocet and Restoril in the lobby. And even then they're going to be irritated about the fact that they have to spend a quarter.

Again, this is always a very small portion of the population. But they're also the folks who fill out the surveys, and the fact that I was the doc who finally said "no" to their treating their regular migraines with narcotics makes me the bad guy. And hey, that comes with the territory. I'd just rather not be penalized for making a difficult but correct patient care decision.

Now I could just complain. But I'm not. This is going somewhere, and it may be the cold medication, but it could also be something revolutionary.

What if we used the system's bureaucratic love of metrics against itself?

Right now, our performance is measured by things like customer satisfaction surveys and RVUs. People have railed against these often and with good reason, since they don't adequately reflect the quality of care we are giving people and the work we put in serving patients.

However, much as we complain about the current rating system, we have not proposed an alternative.

So say we created a system that encapsulated physician performance on a basis that WE felt was more reflective of the essential qualities of being a physician, and incorporated THAT into the bureaucracy?

Instead of endlessly tilting at windmills, we would suddenly have the bureaucracy encouraging good doctoring by noting it as a metric that WE designed. Good physicians would be rewarded, those who weren't would be exposed or would have to work harder at covering their tracks, distracting them from doing further damage.

I simply am not sure where to start or how to quantify this. 360 evaluations could be one thing.

Suggestions?

Thanks,

AF M4

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[edmadison]

Yes you do. Or at most, you're barely adequate:

http://www.military.com/features/0,15240,181737,00.html?wh=news

So here's the thing. I work for a great group of people, but there's no way that all of my "customers" are going to be "completely satisfied" when they fill out their surveys, which in turn play a large role in how I and physicians in general are judged in our performances. (RVUs, of course, also play a big role.)

The problem is, I don't have "customers". I have patients. When you're serving a customer, the customer is always right. When you're serving patients, it's a different story. Again, most people are great. But there's always going to be that part of the population who aren't going to be happy unless I put a gumball machine full of Percocet and Restoril in the lobby. And even then they're going to be irritated about the fact that they have to spend a quarter.

Again, this is always a very small portion of the population. But they're also the folks who fill out the surveys, and the fact that I was the doc who finally said "no" to their treating their regular migraines with narcotics makes me the bad guy. And hey, that comes with the territory. I'd just rather not be penalized for making a difficult but correct patient care decision.

Now I could just complain. But I'm not. This is going somewhere, and it may be the cold medication, but it could also be something revolutionary.

What if we used the system's bureaucratic love of metrics against itself?

Right now, our performance is measured by things like customer satisfaction surveys and RVUs. People have railed against these often and with good reason, since they don't adequately reflect the quality of care we are giving people and the work we put in serving patients.

However, much as we complain about the current rating system, we have not proposed an alternative.

So say we created a system that encapsulated physician performance on a basis that WE felt was more reflective of the essential qualities of being a physician, and incorporated THAT into the bureaucracy?

Instead of endlessly tilting at windmills, we would suddenly have the bureaucracy encouraging good doctoring by noting it as a metric that WE designed. Good physicians would be rewarded, those who weren't would be exposed or would have to work harder at covering their tracks, distracting them from doing further damage.

I simply am not sure where to start or how to quantify this. 360 evaluations could be one thing.

Suggestions?

Thanks,

AF M4

Very interesting article with some good points. Of course, your main complaint is a valid one. Just ask your civilian ED colleagues about their experience. Someone really needs to look at "satisfaction" based medicine and see what effect it has on narcotic and antibiotic Rx. A doc is in a three way vice when he sees a patient with a URI. First there is the standard of care (have some APAP but no ABX), second there is speed, which is money. Third is the patient's desire to get "pills" to cure his non-existant bacterial infection. So what do I do? I can be fast and 1) give the ABX or 2) piss off the patient or I can be slow and 3) educate the patient and maybe get them to accept my advice. Only #1 makes me money. Great system we have.

Regarding some other issues in the article. In my experience, Tricare and the army are horrible about continuity of care. My family members have had their PCP changed multiple times, but that doesn't matter anyway because scheduled fill so soon after they are posted you have to take the first doc available (even for chronic issues). People bounce from doc to doc to NP to PA. The result is that acute issues get addressed and often chronic ones get put off. Unfortunately, this is the nature of a socialized system. A large system is most efficienct when patients are slotted into available openings. The good news is that once the rest of the country is socialized, our system will look better comparitively.

Ed

 

[deuist]

You can't get a hold of your PCP 24 hours a day? I'm shocked. And here I thought physicians went into primary care so that patients could call them at home whenever there's a problem.

 

[deuist]

By the way, I like the idea of using metrics against bureaucracy. Maybe we could have physicians rate their happiness and then use it as a reflection on military leadership.

 

[deuist]

Apples and oranges, Tired. There are systems in place at each base for after-hours care. You mentioned several of them. And while each civilian physician does have a method for after-hours care, too, there is certainly no standardization.