Dr. Colin West discusses striking a balance in patient care

In this installment of “Begin Your Journey,” Colin P. West, MD, PhD, talks with host Scott A. MacDiarmid, MD, FRCPSC, about striking a balance “where we support our physicians in providing truly outstanding care, but give them the system structures in place so that they can actually trust that they don't need to micromanage every perfectionistic tendency, so they can actually nurture the other aspects of their lives outside of medicine to be fully rounded human beings.” West is a professor of biostatistics, medical education, and medicine at Mayo Clinic in Rochester, Minnesota. MacDiarmid is a urologist with Alliance Urology Specialists in Greensboro, North Carolina.

Transcription:

MacDiarmid: I recently gave a little spiel at an incontinence talk. I was talking about MD or "make do" and I said, underline the "M" and the "do." My concern for the physicians now is it's just another issue that happens. Whether it's a computer issue, another rule or regulation, a patient request, a Medicare cut, we just accept it, put our heads down, grind it out, and make do. But what I've learned, [and] what I'm really concerned about for our nation is now we're making do with our health, we're making do with our wellness, we're making do with our relationships with the people that we love. Do you think that that's occurring? Are you concerned? I think when you're highly functioning in medicine, and you're under this chronic stress, even though you're maybe not burned out, it can even change you as a person; it can harden you, and you're just not the same person. What are your thoughts?

West: I think that's right, to an extent. And I think some of this goes back to that physician personality where some of these perfectionistic traits that we have, if we take them too far, we get diminishing returns from effort that really puts us out of our comfort zone. But I also think that we will never be satisfied with doing "just good enough" for our patients. In that one-on-one relationship, that just doesn't fit the professionalism ideal that any medical student I've ever met enters the profession with. So I think we've got to find this balance in the middle where we support our physicians in providing truly outstanding care, but give them the system structures in place so that they can actually trust that they don't need to micromanage every perfectionistic tendency, so they can actually nurture the other aspects of their lives outside of medicine to be fully rounded human beings. That's what we need from our health care structures. And on a note of hope, in that regard, I will say because of increased attention around some of these issues, there are examples of regulations that have rolled back, documentation burdens that have been rolled back. If you think about modifications to E&M billing codes in just the past few years, they've actually become much simpler. In my work as a general internist, this has been actually quite remarkable.

This transcription was edited for clarity.