About five years ago, when I was an employed doctor in Maine, I was the “physician leader” for my particular office of three docs. Pretty impressive, huh? Actually, it was a pick the short straw kind of thing and if you lose then you have to be “physician leader” and go to stupid administrative meetings. Anyway, I had been cynical of the quality fad for ten years by then as I saw it creep its way into my life. My first job in 1997 had the hospital executive show us a chart, a few weeks after hiring, whereupon the bonus structure was based on an awkward RVU scale (don’t worry about not understanding this as no one does) as well as a “matrix scale”. The movie The Matrix was not out yet so I don’t think the dude copied the name but the way the metrics of getting paid were explained it may have well been a scene from the film. I believe “citizenship” was a measurement. No lie. What the hell is that?
Back to my physician leadership role. The meetings started out okay as I tried to be on my best behavior. I would survive by wondering away in my mind thinking of anything else other than the absolute boredom and nonsense being displayed in front of me. At this time I was still writing the Placebo Journal so I justified showing up because it made it easy to produce good material. It was when they brought up the new and exciting concept of measuring quality metrics that I couldn’t take it anymore. No one was giving the downside! All the doctors, and of course the administrator, just gushed over the concept. Why would the doctors not protest this crap? The reason was that most of them were ass kissers so they just wanted to get along. Others were just clueless. I snapped. I had read the book Zen and the Art of Motorcycle Maintenance so many times to know that Quality vs. quality created insanity in the main character. “Quality is a characteristic of thought and statement that is recognized by a nonthinking process. Because definitions are a product of rigid, formal thinking, quality cannot be defined.” So, as best as I could, I stood up and blew away their case for quality. I just broke it down like a seasoned lawyer. If the metric doesn’t fit, you must acquit.
I bring up my past to try and explain the future. This article in Modern Healthcare is called How Perverse Incentives Are Ruining Healthcare and it basically reiterates some of my points from that meeting. I predicted it all. My problem with the author, though, is his use of the term ruining? Dude, it has ruined it. It’s over. Feel free to read the piece yourself but he also doesn’t even scratch the surface of how administrators have destroyed the practice of medicine. They did this to control doctors. They did this to give themselves more power and multiply. And they won. Ruining? Child, please.
Going back to the meeting years ago, I had exasperated the group so badly that one impish little doctor, who was the head medical director of us all, got up and screamed like a little boy, “What’s wrong with quality!?!” Talk about awkward. It was loud, his face was red, he was shaking, and he was really mad. It was almost like a five year old who felt someone didn’t like his finger painting. It was so pitiful that everyone got quiet and there was an awkward silence that felt like an eternity. I guess I was supposed to sit down but I thought, nope, I need to slap this dude’s ears back or make him take a nap, one or the other. I once again put on my best Johnny Cochran imitation and began filibustering the meeting like a pro. I reiterated all my points over and over until they had to call the meeting. From that point on, the medical director wouldn’t even look at me. I lasted another month, at best, before resigning from being a “physician leader”. I never really spoke to the imp again and vice versa. I wish I could now. I would say, “Hey, Dr. Imp, what do you think is wrong with quality now? Dick.”Tweet