Contaminating medicine with mercenary incentives

Some time ago, I endured a medical staff meeting, where attendance is taken and 50% attendance of all meetings is required. I learned that they are serious about this rule when, a few years ago, I was demoted from active staff when I failed to attend enough meetings. This demotion did not demoralize me, as I was only losing my right to vote, which I did not regard as a cherished right with respect to voting on hospital affairs. I learned later, however, that the hospital’s insurance panels all required active staff status of its physician members. I decided that the right to make a living superseded the right to vote. My attendance lapses were remedied and my honor was restored.

Today, a hired consultant was advising us on the importance of improving our patient satisfaction scores. Which of the following reasons to improve were offered to the staff, all of whom regard ourselves as paragons of the medical profession? As in all standardized test questions, choose the best answer:

Improving patient communication improves medical care
Self-criticism is an important exercise for physicians to pursue regularly
No reason needed. We should simply do as we’re told
It will give the hospital PR folks something to crow over
None of the above

While there are many reasons that we physicians should want to improve our relationships with patients, making more money shouldn’t be our primary motivator. Yet this speaker ended his remarks emphasizing that these scores would be directly tied to the hospital’s reimbursement. Of course, this model will be extended to physicians’ offices also. There is something very ignoble about contaminating a noble profession with mercenary incentives. To me, it is doing the right thing for the wrong reasons. I recognize that my idealistic view is vulnerable. It is difficult to reject financial reward to spur physicians to satisfy our patients if nothing else motivates us to do so.

In our hospital, OB/GYN scored extremely high over the past 18 months that measurements were taken. Internists and hospitalists scored low, even lower than surgeons, who are not known for their cuddly bedside manners. I would like to post the graph of all specialties and their scores on this blog, but I fear it is proprietary and would place me in violation of several bylaws. After my prior demotion over medical meeting attendance, I cannot risk another confrontation and the public sanction that would follow. They might withdraw my privileges to perform rectal examinations, which would decimate a gastroenterologist’s practice.

There is a website that should be bookmarked by everyone reading this blog. The Hospital Compare site allows users to compare side by side, hospitals in your neighborhood with respect to patient satisfaction and other measurements. I strongly urge that readers spend some time examining data that your local hospitals are likely omitting in their glossy brochures that they use to promote themselves. The three community hospitals I attend all scored below the national average on the criteria being measured. In fact, using the standard grading scale used in high school, these hospitals would have received a failing grade. For example, only about 65% of patients at all three of these hospitals would definitely recommend the hospital to others. The website also presents other important data on patient outcomes, medical utilization and Medicare payments.

These data can be extremely useful to our profession. They can shake us up and encourage us to reflect and improve. All of us want to be the best we can be. What will it take to get us there? Will we do so because we recall Francis Peabody’s famous aphorism delivered nearly a century ago?