Blog | Thursday, March 10, 2016

Since when is medicine about productivity?


45 years ago I entered medical school to join the medical profession. My father, a psychologist, always expressed great admiration for the medical profession. He strived to convince psychologists that they should hold their profession to the same standards as medicine.

If he were still alive, I can only imagine his commentary about the following common topics: productivity, relative value units, performance scorecards and our inane documentation rules. Productivity has several definitions. Economists define it as :

the rate at which goods and services having exchangecvalue are brought forth or produced.

When did our profession adopt this definition? If I spend 1 hour talking with a patient, examining that patient, reading old records, going to the literature to answer some questions, going to radiology to review the films, calling a consultant and then explaining everything to the patient, I represent lousy productivity. But I have demonstrated great professionalism. We entered medicine to help people. The patient's welfare is the main goal.

Where is the patient in the productivity definition? How much time should we spend with each patient? I would argue that we should spend the proper amount of time with the patient to address the patient's problems. Some visits are rather simple, but some visits are very complex. We have short visits and long visits. Sometimes we need to do significant work away from the patient.

The adoption of the term productivity has, in my opinion, a destructive influence on our professionalism. Similarly, RVUs give the same undesirable message.

Our payment schemes are driving these terms. When I hear them, I hear fingernails scratching on the blackboard. How do these terms impact physicians? Obviously, I would argue that they redefine our profession in negative way.

We all need to reconsider how to define our professionalism. We need focus on how to best deliver excellent patient caring. We need to focus on how we can best serve our patients. Sometimes that takes longer than the formula dictates we should spend.

So please do not describe productivity equations, or bonuses based on RVUs. Please do not explain coding, upcoding and downcoding. Please tell me stories about how you help the patient achieve their health needs.

As Voltaire first said, “The people's representatives will reach their destination, invested with the highest confidence and unlimited power. They will show great character. They must consider that great responsibility follows inseparably from great power. To their energy, to their courage, and above all to their prudence, they shall owe their success and their glory.”

We have great power, and thus we have great responsibility. We must continue to explain that responsibility to all those who threaten our professionalism. Our patients deserve our commitment.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.