Perception or reality?
The saying goes that if the truth is not visible, then “perception becomes reality.” As a leader in a large academic center, I am always focused on how we are perceived. Our patients choose us, trust us, and continue to rely on us based on their own perception of our quality. While we publish metrics about infection rates, mortality rates, and how satisfied our previous patients have been, each of our patients brings to us a preconception of what he or she believes to be quality. This, I believe, is because quality is truly in the eye of the beholder.
A patient undergoing cardiac surgery expects to go through the procedure without a complication (a wound infection, a heart attack or stroke, a need for longer hospitalization, etc.). This same patient, though, when asked about quality may measure quality based on how fast they can get back to golf or work, or whether the health care team treated them with respect and kindness.
I believe our patients want to trust in us and know that we will provide them with high quality of care, free from preventable harm, in a compassionate way. They want us to heal them, keep them safe, and know them for their values and their choices and ultimately deliver our care to them with empathy and compassion. For each patient, the “metrics” for this are varied. This is the basis of the quality conundrum.
I am writing this blog because I believe that, due to these many complexities about what the quality reality is, our patients will rely on their perceptions. I am deeply disturbed by two recent events.
First, in recent conversations, I have asked many of you if you have seen the new TV show about the life of a trainee in a large medical center, perhaps not unlike ours. The show portrays so many negative, and some horrific, events as routine occurrences. The health care workers, specifically physicians and nurses, lack accountability, self-control, honesty, and integrity. The leaders are without ethics and rules, and they value dollars over patients. I am concerned that this sensationalized portrayal of individuals—from leadership, to physicians, to nurses, to support staff—will be seen by patients and families as reality. I believe it has the potential to harm the trust our patient have with their physicians and their care teams. You may say, “It’s just TV.” Yes, I know, but I also worry that the advent of “reality” TV causes perceptions to blur, and fiction may be perceived as reality. Especially as those fictitious shows seek to promulgate and cash in on the urban legends of health care.
This brings me to the second recent event that has been in the media: the trial of Dr. Larry Nasser. When a physician steps away from the duties and responsibilities entrusted to them by the patient, and performs actions that are unethical, the profession, and thus each of us, is injured. When a physician uses his powers to exploit and assault young persons, it makes the average person wonder about our profession as a whole. This sort of behavior is so far from the norm that I as a physician and human being cannot comprehend how one can become so lost.
What can each of us do about this? We must never allow our colleagues, patients, and their families to worry that our integrity and good will is in jeopardy. We must see each patient as an individual who has stories and worries and who suffers—not as a diagnosis, a room number, or an object.
Each of us came to health care in order to care for people. These examples, one contrived and one real, put a stain on our profession, and we must not allow that to happen. We can counteract erroneous perceptions by showing our patients, their families, and our colleagues that we always have our eyes on the prize – the health, well-being, and safety of the most important part of our team – our patients. We do this by being an integrated team, focused on quality and safety, and by communicating with each other and to our patients in a clear and compassionate way. We do this by holding ourselves and each other accountable to achieve our goals and to live our values. We do this by being transparent about where we are doing well and where we have opportunity. Most importantly, we must look at each opportunity to improve our patient care and perception of us, in order that we make that perception consistent with our reality.
We have exceptional people within UI Health Care who work each and every day to create our stories of human dignity, success, and kindness.
—Theresa Brennan, MD, Chief Medical Officer