Today I walked into the hospital and was greeted by
a poster proclaiming “Physician’s Awards for the Quarter”. There were five
awards presented to five different doctors. The categories were: “Best
Teamwork”; “Best Documentation”; “Timely Discharge”; “Highest Patient
Satisfaction”; and “Best Hand Hygiene” (seriously).
What I found remarkable about these awards was the
lack of anything that had to do with true quality of care. Medical school
teaches that patients’ outcomes are the most important measures of a doctor’s
skill. Accurate diagnosis, appropriate treatment and intervention which leads
to a smooth and uncomplicated clinical course; this is the goal every physician
should strive to reach. Those five categories of awards certainly contribute to
the ultimate objective, but should these five items be elevated above all else?
Apparently, this particular hospital values these skills above all the other qualities
that are part of being a physician. Therefore, in the spirit of competition and
the current Olympic Games, I’ve begun a training regimen that will lead me to
garnering one, perhaps all, of these coveted quarterly honors.
Start with “Best Documentation”. I’ve been
diligently working to lengthen my admission and progress notes by adding a
wealth of superfluous detail that I’m sure will contribute to near perfect
outcomes for my patients. Surely every patient admitted with a bowel
obstruction caused by an incarcerated incisional hernia demands daily
documentation of their history of pet ownership as well as the make and model
of the first car they may have owned. I’m doing all I can to match the record
of a hospitalist I’ve worked with, who used to do a complete 5-6 page history
and physical on every one of his hospitalized patients on a daily basis. This
extraordinary documentation was topped off , after sifting through all the
pages of redundant information, by an illegible assessment and plan. I’m sure I
can exceed even this lofty standard.
It may be a bit more difficult to garner the gold
for “Best Teamwork”. Unfortunately I still ascribe to the archaic model of
physician writing orders on patients, having the nursing staff then read these
orders and carry them out in a timely fashion. Obviously, such a dictatorial
system cannot survive in these progressive times. It is true that there have
been times in the past, mostly out of frustration, when I’ve crossed out the
word “Orders”, a common heading at the top of the page in the appropriate
section of the chart, and written in “Suggestions”. But, such an act is most
definitely unenlightened and will never help me in my quest for this coveted
award. I’m just going to have to begin to manage my patients by committee, with
the therapeutic plan coming from a joint decision fostered by all the
interested parties including physician, nurse, respiratory therapist, physical
therapist, dietician, patient aid, hospital administrator and insurance
company. Teamwork at such a level cannot fail to be rewarded.
But, what about “Timely Discharge”? Surely, first
place honors are out of reach for a General Surgeon. After all, it almost
always takes several days following the typical colon resection until the
patient is ready to eat and be sent home. There is no way a surgeon can compete
with those internists who can begin treatment for pneumonia or a UTI and then
ship the patient off to the nearest Long Term Acute Care hospital. I don’t see
a simple solution. I suppose I could transfer all my post op patients to an LTAC
under the care of an internist. It’s true that the patient may suffer, but I
would only utilize the most skilled internists and the finest lower levels of
care. And, we’re talking about individual glory here; patient outcomes must
take a back seat.
“Highest Patient Satisfaction” should be one of the
easiest awards to win. All I would have to do is not charge for my surgical
services. Perhaps this would be a bit too drastic. Maybe a rebate on the
services rendered, $50 for cholecystectomy, $100 for a colon resection, and so
on. Even this may be too much. I think a $5 gift certificate to Burger King
would suffice and would be much simpler, and more appreciated, than actually
taking the time to listen to the patient, or explaining the proposed treatment
plan and potential complications. Something tangible is always better than
empty words.
Finally, there is the most competitive and closely
judged competition “Hand Hygiene.” I’ve thought long and hard about the best
way to compete. Of course, I wash my hands over and over again, every day.
Obviously, something more is needed. Therefore, I propose to take personal hygiene
to a new level. Instead of mere handwashing, I intend to wash myself completely
from head to toe before entering a patient’s room. In the interest of total
cleanliness I have proposed to the hospital administration that every patient
room have a place, for those physicians that are serious about stopping the
spread of some of the nasty “bugs” that inhabit our hospital, to completely
disrobe, thoroughly sterilize their entire body and then don sterile garb. Such
hygiene will make the hospital the envy of every health care facility in the
world and all the nasty infections and resistant bacteria we battle will
vanish, almost overnight. A bit pricey? Perhaps, but the desirable “Hand
Hygiene” award would be mine for the taking.
