Honestly, a mental war happens. When your outcomes are measured, you begin to truly think of the impact of the decisions you make. How quickly should change happen? If I continue treating this person, my clinical performance portfolio will reflect I over treated.
The new FOTO patient specific reports at times smack me up the side of the head with, "what are you thinking, Girl?" For example, take this report. By all means, living in the outcomes world and focusing on being effective and efficient would have indicated services should have been discontinued on 7/2/2015.
I still remember that mental sigh I had as I discussed the report with the patient. By all means, I knew the science was telling me to discontinue the episode of care. I knew any further treatment would potentially hurt my rankings (Yes, FOTO internationally ranks clinicians based on a combination of how effective and how efficient they are.) In my heart, I knew this particular patient needed more time. You see, she is a recreational roller derby player. She was just beginning to get back into her sport and I needed a bit more time to fine tune her performance to reduce the risk of injury.
My focus was on her final functional score versus the points of change. Change is good, but for this situation and her particular sport, I knew in my heart, I couldn't be selfish and focused on myself and my rankings. She deserved more than what was predicted.
As we head down a road that judges us by the quality we provide, are we willing to maintain a strong external focus on our patients and do the right thing even when the right thing may affect how quality is measured? I know I have mentally decided that the situations like I am sharing today are hopefully outliers.