A little box pops up before him asking if he asked the patient about the exercise. He mumbles something under his breath, clicks a little box beneath the question, then moves on.
This is what medicine has become: a series of computer queries andmeasures of clicks.It must be measurable, quantifiable, and justifiable or it didn’t happen.
Do they ask if I asked him if he used cocaine? Of course not: too politically incorrect.
Do they ask if I really listened to her heart? Of course not – this activity is not a paid activity.
Do they ask about the myriad of phone calls and e-mails to arrange for a procedure? Nope.
Do they measure my time with the patient when I go back to see them on the same day? Nope — not paid for.
So what’s the motivation for doctors to be doctors? Are we retraining our doctors from care-givers to data providers? What are we losing in turn?
An excellent opinion piece by Daniel Henniger appeared recently in the Wall Street Journal.In it, he references an importantarticle by Drs. Christine Cassel and Sachin H Jain published in the June 17th issue of JAMA entitled “Assessing Individual Physician Performance: Does Measurement Suppress Motivation.” Cassel and Jain are two shapers of the Pay-for-Performance movement but acknowledge the danger this movement has on physician behavior:
Overstating the value of discrete quality measures has the potential to demotivate and demoralize physicians who appropriately view their job as much more than simply meeting a standardized measure set.
This point cannot be overemphasized.
Doctors are losing their motivation to diagnose in favor of sitting at a computer. Doctors, I also dare say, are losing their skills in favor of sitting at a computer. Clicking buttons has such importance to health care systems that these performance measures are being linked, in part, to doctors’ salaries. As a result, young doctors are losing their complex problem solving skills in favor of making sure they click on every result that comes to their inbox, lest they be seen as nonproductive. This, you see, is what matters to employers.
We are reshaping medicine away from the bedside to the computer.
We’d better understand thedamage this shift is causing before our young physicians of tomorrow don’t know any better.
By Dr. Westby G. Fisher
Dr. Westby G. Fisher is a cardiologist at NorthShore University HealthSystem who writes regularly at Dr. Wes.Visit website | More posts by Author
Very well said. The day I looked at the new electronic medical record for the emergency department was the first day I seriously considered retiring completely. After 38 years in the pit, having jumped through every hoop in two specialties, I could not imagine myself discarding all of my multi-tasking skills and neglecting my patients to document my competency and proficiency on a child's toy that interupts my brain's ability to instinctively know what I should be doing next. This is not progress. It diminishes productivity. It destroys my peripheral vision of an entire department, something I spent decades honing. This tool, along with the Press-Ganey insanity, is destroying the very things that we worked so hard to master. We must now "satisfy", even if it means giving narcotics to addicts, antibiotics to patients with viral illnesses, and encouragement to the street alcoholics to come back every night to occupy one of our precious stretchers. I represent the old guard, the last of a baby-boomer breed that learned how to recognize BS a long time ago. We wish you well and hope that working for marketers and bean counters and the federal government for the rest of your life works out. Personally, I'm glad that almost all of my career was in "the good ole days". Now that I'm fully retired I realize that I could have been productive a few more years, but not at the cost of my integrity or the adoption of systems that negated the skills that required decades to fully develop. May God have mercy on your soul.
Charles C. Anderson M.D. FACP, FACEP @ @facebook.com/charlieandersonmd @ twitter.com/DocCAnderson