During my India trip, one physician told me this story. I will try to get the gist of the story correct. He told the story in response to my lecture on the dangers of guidelines and performance measures.

He was practicing in England at the time this incident occurred. England had just started their P4P project. An older woman was going to see her physician. She was having symptoms of uterine prolapse. Her daughter accompanied her, but she did not let the daughter come into the examination room because of embarrassment.

The physician comes into the room and starts reviewing each of her known medical problems with a focus on those issues that would impact his performance measures. He never asks for her agenda, and abruptly finishes the meeting.

The woman goes back to the waiting room, and has to tell the daughter that she never had a chance to seek help for her concern.

Performance measures can change the physician patient interaction. We are told that medical care should become more patient centered, while focusing on performance measures changes the physicians priorities. We do not have a good measure this concept.

Since quality has many dimensions, we must worry that focusing on some dimensions will decrease our attention to other important dimensions. This story describes a bad medical visit. But the physician likely scored perfectly on his measures.