What a horrible question that always was.  You came to work and a friend would come up to you quietly and take you aside.

‘Remember that guy yesterday with the chest pain?’

‘Mr. Hayes?’

‘Yeah him.’

‘What happened?’

‘He came back with a heart attack.’

‘Oh wow I feel terrible.’

It wasn’t always bad news.  Occasionally it went like this: ‘that child with leukemia you diagnosed last month? His mother stopped by to say he’s doing really well.  She brought you some brownies.  We ate all of them. But great job!  And awesome brownies!’

In years past someone in administration would send a note.  ‘Good save.  Thanks for your hard work!’  Or, in academic centers, there would be ‘Morbidity and Mortality Conference,’ where bad outcomes were discussed.  Terrifying, but educational.  And sometimes brutal.  (Everybody is a Monday Morning Quarterback…)

I recently realized that we still get feedback. But it’s like this:

‘Please complete all the charts in your in-basket.’

‘You have ten outstanding dictations.’

‘You forgot to document your critical care time for billing.’

‘Your charts are being down-coded.’

‘Your throughput times are too slow.’

‘Your satisfaction scores are not high enough.’

There’s a huge difference.  The old way was about the practice.  About the joy and pathos, the science and art.

The New Way, the New Deal, is about the document, the data, the bill.  And oh, a little bit of patient care thrown in for goood measure and theatrics.

Remember that patient?

He’s a number now.  And a bill.  And that’s about it.

So finish your chart.


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