Shadow Dancing – going to be where the patient is

One of the greatest things I heard from a CEO of a health care company I really admire was, “Sometimes I go back to my office and ask myself what the heck I am doing.”

And, sometimes I go back to my office and ask myself what the heck I’m doing.

I am just finishing up a week (more or less) of visiting a total of four different health care organizations, in the San Francisco Bay Area. It was a great week. I never know what I’m going to see or learn when I do this, and I learn a lot. The reason for this is that I do shadow – asking to go into the exam room with patient and physician (after proper consent). I typically don’t sit down with people at meetings, and instead talk to them on the fly, in the context of patient care. Sometimes I will give a presentation, on request, which I am happy to oblige.

It’s a bit of an unusual way to learn, and it can be challenging to get there in the first place. This includes everything from knowing my tuberculosis status (to protect patients I may come in contact with) to understanding privacy practices and protecting the security of medical information.

When I visit a practice, there is invariably a conversation that starts with, “who are you and why are you here?” I have a bit of an elevator speech that I’ve developed over time. The reality is, that in medicine, it’s not the “norm” to perform quality improvement a little at a time. People are used to data-driven quality, which can take months to compile and more months to release as people discuss methodology. They don’t really watch each other practice and critique and improve on the fly. So, I sometimes find myself in a situation where I have to represent my value very quickly.

The good news is that I have been uniformly welcomed, even by busy clinicians, which has been so impressive to me. Some of the clinicians I am following are not having the smoothest days, and some may not be having the smoothest weeks or smoothest months. And, that’s okay. I’m a visitor serving them, not the other way around.

In a health care system where quality happens every day, a bit at a time, it would be more likely that a physician (or nurse) would be shadowed by a colleague, and so my presence wouldn’t be a novelty. But that’s not the case, so every new request to shadow is going to bring a challenge with it. It would be much easier to acquire information by setting up meetings, but I think the quality of information would be inferior. So, I’m not going to do that, but I will set myself up for disappointment and maybe even failure, if an organization or practice feels that there isn’t a need to have me observe what they do.

The reason why it’s okay, to do this more complicated thing, is because of all of the things I have seen and heard, the moments of “the heart of family practice” that I have had in every place I’ve been. Maybe one day all patients will expect to see another physician in the exam room with their own who is working to help their colleague to be a better doctor.

Such is the life of the change agent….

Ted Eytan, MD