Performance measurements for physicians are well-intentioned and get me to rethink how I practice. But in the end I won't make the goals, so I'll have to go with balance over perfection.
It’s the third week of the month. That means a bright yellow spreadsheet is on each of my exam room doors every day this week. It’s a timing sheet - it notes when the patient arrives, when he is brought back to the exam room, when I arrive, when I leave, and so on. It’s used to measure how long it takes the medical assistant to room the patient, how often I’m “on-time” which is defined as entering the room within 5 minutes of the patient’s appointment start time, and how many minutes total the patient has to wait. As a goal-oriented, Type A, perfectionist, I want to do really well …perfect even.
But I can’t. My ten o’clock patient arrived 15 minutes late, so I was perfectly 15 minutes late for the rest of the morning appointments. Doesn’t matter though, they all counted as me being late, even though the fault lay elsewhere.
The purpose of the timing sheets is not punitive, rather it is informative. If a physician is chronically behind because they are templated for 15-minute appointments when it actually takes them 17 minutes, on average, per patient, then something needs to change. It is a good indicator to me of how long I actually spent with a patient. Sometimes I feel like I’ve been in there 45 minutes, but it’s actually only been 11 minutes.
Nevertheless, I try to do really well.
We’re also measured on how quickly we close the electronic chart with a goal of within 2 hours of the appointment. Again, this is not punitive - the goal is to have physicians avoid batching and saving charts up for the end of the day. My employer’s goal is that I am walking out of the office within 30 minutes of my last patient leaving. Since we’re measured, I also pay attention to this metric, trying to get my charts closed on time.
On the surface, this type of measurement can seem bothersome. I mean, what really matters is that my patients get great care, not whether I arrived 5 minutes or 8 minutes after the appointment starts. As long as I write a detailed and appropriate note, why does it matter whether it is done 1 hour or 14 hours after the visit?
However, these reminders and standards can be instructive - showing me in stark detail how long my patient has been waiting for me. It is painful to recreate a visit hours after it has concluded. I’m left wondering whether it was the right ear or the left ear that was infected or which patient had the heart murmur. So, I realize these standards, as bothersome as they may be, are helpful. Ultimately, if I can be on-time and complete my notes, the day does run more smoothly.
All of that said, I actually can’t meet these standards. If I try to close all my notes on time, I am invariably running late. If I try to make a concerted effort to be on-time, I get waylaid by the late patient or the double book or the emergency and all of my appointments after that are late because of the downstream effect.
So, like in many things, it’s all about balance - trying to balance the ideal or the standards with what is practical and achievable and important.
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