Mommy Doc Madness: Atta Boy!

June 6th was my 25th wedding anniversary! My husband outdid himself. He gave me a beautiful anniversary ring, three dozen red roses and took me out for a romantic dinner. He is truly my soulmate, and I am blessed beyond measure. I headed into work the morning of my anniversary on a high, admiring my sparkly ring and thinking about how blessed I am to have such an amazing family. That high spiraled into a devastating low in a matter of minutes.

I opened my email just before seeing patients and started reading our patient experience comments for the last quarter. My heart sank. I was horrified to read some of the most negative reviews I have seen in my 15 years of practice. As with any service profession, we are graded on our customer service. Our patients are provided patient experience questionnaires after seeing us. The results for these questionnaires are compiled and made public on our CHS website. When the decision was made to make such comments public, I was an advocate. We can be rated anywhere on the Internet on sites like Yelp or vitals.com. Because Internet searches are based on the number of responses, our organization decided to take control of our own reputation by publishing the true results from our own surveys. I championed the initiative! As a scientist, I believe that validated data is better than random opinions. Now, however, seeing these comments on our “legitimate patient experience process” feels demoralizing and demeaning.

One patient complained about the amount of time I spent looking at the computer. Specifically, the patient mentioned that he/she had been my patient for years but had lost confidence in my care because I spent so much time doing administrative work in front of the computer. If only I could lift that burden myself! I've written before about the burdens of electronic medical record (EMR) and how frustrating it is to spend so much time tied to it. The EMR, if used as a clinical documentation tool as it was intended, would be great. On my medical mission trips to Haiti, I get to experience the joys of an EMR for pure clinical documentation. It is awesome! But, with the regulations of the Affordable Care Act and Meaningful Use of it, EMR tasks often feel completely meaningless. Instead of documenting patient care, we are feeding a coding and billing tool. The irony is that over the last year we have redesigned the way we deliver care to have clinical staff in the room with us helping to lift that electronic burden. I have also been intimately involved in that process, trying to make the practice of medicine better for patients and physicians. Now, the only visit type at which I still sit at a computer is a preventive exam. And during preventive exams, we should be focused on prevention, not problems. Seeing this comment made me very sad. Despite all of our efforts, I failed this patient.

The other complaint was about our lack of concern for the patient's trending labs and the patient's inability to get us to call them back. I don't even know how to interpret that comment. With every single lab result letter, we comment on any abnormal lab. Furthermore, we know that sometimes our laboratory has erroneous trends and meaningless values. Because every lab value is transparent to patients, this patient likely is seeing a value and does not understand its relevance in the context of other normal labs. And, as part of our care redesign, we use call centers. I have no idea if the message for me to call the patient back actually ever reached me. Again, I was sad. I failed this patient too. Because these comments are anonymous, there was no way I could reach out to these patients and do any service recovery.

Sure, there were lots of nice comments and kind words. And, I still have a 5-star rating with 4.86 out of 5 stars. And, I had just received a home grown bouquet of roses from another patient the day before. But, those are the comments I remembered and chewed for hours, beating myself up on the inside.

And, the hits kept coming. Just a few days later, a patient came in complaining that I had been unavailable to see her the week before. She had been seen by one of my partners who covers for me in my absence. I am in the office four out of five days a week. And I knew she had been seen and even consulted with that provider. However, she made the comment she may have to find another place for her care if we could not meet her needs, seeing her when she wanted to be seen. Ugh. I had failed her too.

The next day, it got worse. I had a patient who came in with a family member truly angry and upset with me due to an interaction a week or so earlier. At the earlier encounter, the patient was reestablishing care. I had not seen him in over two years. At that visit, he recounted a complicated story to me concerning an injury for which he was receiving care from multiple different providers in multiple locations. I was asked to write him out of work for the treatment of this condition. I explained that he needed to find care in one location and that the doctor or doctors providing that care needed to provide a work excuse. Although I thought I had explained this well, I did not. The patient stated that I made him feel judged for going to multiple doctors. Furthermore, he had walked out of my office feeling worse than he walked in. Well, I failed to do no harm. I have cried with patients on multiple occasions, concerning a devastating diagnosis or a seemingly insurmountable social situation. This time, however, I cried because my heart hurt.

Rock bottom. I was there. I sat in my office, staring at the computer screen and just cried.

A few hours later, I walked into see a longtime patient who happens to be a college professor. He could read my sad demeanor, and likely saw evidence of smeared mascara on my face, and asked what was wrong. I shared that I have been pretty devastated by some patient experience remarks and a few patient interactions in the previous days. He smiled kindly and reminded me that in his profession, he teaches 200 students in each class, with several classes each semester. At the end of each class he also gets student ratings. He said that 190 of those reviews tended to be glowing. But, the last 10 or so said he was the worst professor ever and that the student didn't learn anything in the whole class. Like me, the ones he tended to remember where those last ten.

Yep he's right. He then shared with me a pearl from his years in the Navy. He said to remember:

One “Oh Sh%t” cancels a thousand “At a Boy’s” I just chuckled. I’d had a week of “Oh Sh%t.” I needed that laugh. This whole week has really made me assess my need for the approval of others. Yes, I need to be a compassionate, competent and caring doctor. That is my calling and I know that full well. But, I also need to realize that I will never make everyone happy. In all of interactions with patients, family and friends, I need to ask the words of Paul:

Am I now trying to win the approval of human beings, or of God? Or am I trying to please people? If I were still trying to please people, I would not be a servant of Christ. (Galations 1:10)

Lord, help me embrace the wisdom of 1 Thessalonians 2:4 For we speak as messengers approved by God to be entrusted with the Good News. Our purpose is to please God, not people. He alone examines the motives of our hearts.

Keep my heart pure.