A week and a half ago, the Times published this op-ed that eloquently discusses the current obsession with metrics in healthcare and education. Most importantly, Dr. Wachter manages to thoughtfully address the fact that most of our metrics are fundamentally flawed- but that doesn’t mean that our patients (or in the case of education, students) do not deserve quality from us.
Wachter’s piece, of course, comes out on the heels of multiple recent discussions about burnout in healthcare, and among physicians in particular. It’s not that physicians don’t want to deliver high-quality health care- we do, and we want to provide high-value care as well. But, again, the metrics are fundamentally flawed, so things we’re supposed to be doing to capture quality of care are often (1) unsupported by evidence and (2) incredibly cumbersome. Anyone who has dealt with the Epic EMR knows what I’m saying here; while Epic is great for getting the “Meaningful Use” boxes checked, I often can’t tell a thing about what’s going on with a patient after reading a templated note that contains all of the requisite billing and MU elements.
The quote from Donabedian that is embedded in Wachter’s op-ed that was most striking to a few of us (I know that two of my respected colleagues commented on it on Twitter) was, “The secret of quality is love.” I’ve spent the last week really pondering that sentence and what it means for us in healthcare, for those in education, and in particular for those of us who work in the liminal space of medical education. Last night I was talking to my Mom about my belief that we all have to do a certain amount of stuff that we just have to do as part of our job- what I refer to as “eating your broccoli” (no offense to brassica vegetables). However, in a high-functioning system when we are established in our careers, we get to spend most of our time focusing on the things that light us up. We become primarily busy doing those things that we are fundamentally excited about getting out of bed for on most days. Chances are that those things we’re really passionate about doing still have aspects that can make us a little crazy at times- but because we care so much about what we’re getting to do, those annoyances are magically diminished. Linking this concept back to the topic at hand, because we’re so enthusiastic about what we’re doing, we likely do a better job of whatever that magical thing is. Thus love (or passion) = quality.
And maybe, just maybe, getting to do those things is a remedy for burnout as well.
“Not all of us can do great things. But we can do small things with great love.”- Mother Teresa
And that, with any hope, is the secret ingredient to all of it.