Different metrics

Different metrics (by me)

The day unfolds at 8:15,

in quarter-hour intervals,

back-to-back-to-back visits

full of numbers.

 

HGBA1C of 9.

Hemoglobin of 5.

Cholesterol of 280.

Creatinine of 3.

FRAX risk of 18%.

Ready in room 2.

The doctor grits her teeth,

trying to make sense of it all,

explaining the values to a patient,

and hearing their struggles,

while trying to motivate changes in behavior,

wondering why the industry

set a fifteen-minute limit on a patient's needs.

"Better access" is one reason.

"The bottom line," we hear again and again. 

Visits could stretch longer...

they often do run way over. 

Because, with hope, the patient will be treated

not just as a number, 

but as an individual.

Even though the clicks need to be done

(there are too many),

and the words need to be typed,

the orders signed, faxed, and the chart closed, 

the patient's story, 

their personal successes,

and all of their pain, 

can’t be measured,

or compartmentalized,

so easily.

We wish we could help them all,

do all the things,

check all the boxes,

meet all the measures, 

and help them with all they want that day.

But there are so many patients,

and not enough doctors (nor nurses or assistants), 

a ratio both unsafe and unfair. 

There are only so many hours in each day. 

And we are humans, too.

The doctor runs, 

room-to-room, 

typing while listening, 

mind racing ahead, 

counting how many more visits there will be,

calculating how many more notes there are to write,

trying to get out the door on time to pick up her own tiny humans,

with their own long days, 

list of complaints, and needs.

She tries not not to drown under the click burden 

and administrative requests, 

sometimes after pulling an all-nighter,

and it's all so costly.

“Can you squeeze one more?”

the front desk asks.

The time card submission form asks, 

"Did you take your breaks?"
(What are breaks?)

What if the metric was not "productivity,"

but empathy?

What if the health care system listened to patients,

and doctors, 

who value quality, 

over quantity,

who strive for connection

over QI quotas.

What if we deferred the pap for a bit,

so we could instead treat the person in front of us,

whose values are not always concordant with 

the system's "values."

What a difference we could make,

if we could sit quiet, calmly, 

be present, 

listening with more than just the stethoscope, 

but with our open hearts,

having the space and time  

to touch both our patients' bodies, 

but also their souls.

Different metrics indeed.