Numbers – we are surrounded by them in the hospital.
The first thing I do in the morning after arriving is “get the numbers.” Overnight vital sign trends, blood counts, hemoglobins, creatinines, other labs.
Myself, my group, my hospital – we are judged by numbers. Numbers of patients seen, RVU’s, satisfaction scores, length of stay, 30-day readmission rates, and many more.
As a scientist, I like numbers. They are quantifiable. They are “objective,” (though they often fall far short). I base many of my medical decisions on numbers. Residents and medical students I teach learn about diseases and pattern recognition in part through numbers (vital signs, labs, other signs/symptoms). And patients I care for are often hungry for numbers to help them understand what to expect from a disease. One of the first things a patient or family asks after a diagnosis of a terminal illness is “how long do I have?” We can help them to some degree. We can fit their numbers into an algorithm or previous studies to come up with some new numbers that may apply to them.
But numbers are not the be-all and end-all in medicine. Occasionally they can instead be a barrier to taking good care of my patients. They can be misleading – I will be the first to admit to being misled about a diagnosis or clinical course by putting too much faith in lab values or vital signs over how a patient looked or felt.
When I was in medical school and residency, we had to “get numbers” by actually going to a patient’s room and looking at the clipboard outside the room. Our local VA had an electronic medical record, the first of any of the local hospitals where I worked. For the first time we could actually see vital signs and labs on the computer screen. What a revolution for a stressed and overworked resident! All of a sudden instead of going to a dozen different rooms and talking to patients and nurses, we could sit in a (windowless) room as a team, sip coffee, and complete a good bit of our work without even getting out of the seat. In a not-so-proud moment, I remember once even being annoyed that I had to actually go see and talk to a patient. I mean – come on! What can I learn from them that I can’t learn from the NUMBERS?! In my haze of fatigue and stress, I had lost sight of the importance of the person behind the numbers.
I went into medicine to use science to help people. I am reminded time and time again that it is the connections that I develop with my patients that I treasure. On some of my busier or overwhelming days, remembering this can require effort. I have a great job, and I am humbled that people put their trust in me to help them feel better when they are feeling ill.
Often patients feel better coincident with numbers looking better, but this is not always the case. We are all familiar with patients who “look a lot better than their numbers.” And sometimes the best care I can give to a patient is reassurance that it’s time to stop looking at numbers and focus entirely on how they feel in the face of worsening ones. Reassurance that we can treat symptoms and make sure that they are not in pain, short of breath, or suffering in other ways during their last days. Reassurance that I will continue to care for them as they are dying – that I will not “give up” on them, even when I can’t cure them. And often our social workers, spiritual advisers, nurses, and others do a far better job of relieving overall suffering than we do as physicians.
Numbers are an important part of my practice. They help me guide my patients through their diagnoses and treatments. They can give me an idea of how productive I have been relative to colleagues. They can point out deficiencies leading to opportunities to do better.
But I also challenge myself and my colleagues to get far beyond numbers in our work. We must connect with our patients on a personal level to deliver good care. We need to delve deeper than diagnosis, labs, length of stay, risk for 30-day readmission, and other trackable parameters. We should be working to understand how our patients’ lives are impacted by their burden of disease, whether large or small. One of our privileges as physicians is that patients put their trust in us to make them feel better when they are feeling sick or vulnerable. What an honor. We owe it to them to do our best to care for them as a whole person.
Patients can detect when doctors are detached, waiting to get on to the “next diagnosis” in the next room. It does not feel good. When we as physicians connect with patients on a personal level, I suspect that many of the “numbers” will improve, as our patients get better care.