Rebel MD: My Professional Thanksgiving

The following comes from the Rebel MD blog.  It echoes my sentiments exactly.  Often,  when you are caring for patients, there are intangibles in your relationship with them that cannot be quantified in a government imposed metric.

In fact, I would argue that only focusing on metrics can do more harm than good because of unintended consequences.  For example, if a doctor is penalized because he has an inordinately high number of uncontrolled diabetics and/or smokers, does that automatically mean that he is a bad doctor?  Perhaps that doctor is the only one willing to take care of all the patients that come through his or her door, regardless of what their numbers look like.  I am now hearing that some doctors who focus on “quality metrics” refuse to see these because they will make their numbers look bad, and they won’t make as much money under the new system.  What kind of system are we building if doctors will be punished for caring for the sickest of patients who are in the most need of their medical expertise?

With the Direct Primary Care model we have adopted, this issue has been taken out of the equation.  We focus on treating our patients, not some bogus numbers that the government wants to judge us by.  I know I am happier for it, and I think my patients are too.

Michael A. Ciampi, M.D.

My Professional Thanksgiving

Photo by woodleywonderworks

Yesterday, I received a thank you note from a patient that prompted me to write this post. The note started with “Dearest Dr. Cavale!!!” and continued “I just wanted to say thanks for your kindness. Even though you keep wanting me to stop smoking…(your) professionalism and warmth is very soothing”. It ended with “Your way makes having diabetes not so frightening”.

I was gratified to know that my patients (at least one of them) appreciated the type of service I sincerely wish to bring them. Upon further introspection, I realized it is I who should be thankful – thankful for every patient that trusts me with their life every day. I am eternally grateful to each and every patient that has sought my professional help, and hope I have been able to alleviate some part of their suffering or illness. I am thankful for these common folk, without whom there would be no practice to operate.

Which brings me to the rather steely reality that Medicare will be judging the quality of my clinical care based on “metrics”. I wonder if there is a metric for kindness or professionalism or warmth or soothing.  How does one quantify these qualities into numbers? In the new world of “value over volume”, will these qualities really matter anymore? And, what will happen to these qualities that patients hold dear, when the only way physicians are judged will be metrics? And does anybody ask “value for who?”.

My professional thanks is a pledge to my patients that, as far as I am concerned, the only metric I care about is their trust and satisfaction. To this end, I have enlisted many of my colleagues to sign this pledge:

I urge those of my professional colleagues who have not signed this pledge, to please join me in thanking our patients with this pledge that we will allow only our patients to determine the value of the care we provide. We owe it to our patients and our profession.

Dr. Arvind Cavale is an endocrinologist in private practice in Pennsylvania, you can follow him on Twitter @endodocPA


Photo by woodleywonderworks 

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