Miriam Fine-Goulden: Unmeasured interventions

For my next job application, ask me how I make people feel, because that’s what you really need to know

miriam_fine_gouldenHow do we measure our value as clinicians? Throughout medical school and subsequent specialty training, I was warned “publish or perish”. This is a seam that runs through our entire professional lives. It is easy to count publications and presentations: to tot up impact factors and citations to show the quality of our work, providing evidence for how we have been spending our time, and to quantify our worth. As clinicians, we understand the currency of academic contribution: there is a clear hierarchy of studies (from the multi-centre, double-blind RCT to the lowly case report) and of listed authors (the honour of “first” or “last”). Statistical significance is measurable and clinical significance demonstrable. Doctors who wish to work in competitive specialties, but never plan to continue in academia are advised to “get a PhD” in order to bump up their CV, even if they have limited passion (or indeed skill) for the subject. Seminal publications become milestones of medical history, and who would not wish to be the author credited with “the paper that changed my practice?” But for clinicians who contribute in myriad other ways, quantifying value is a far greater challenge.  

“An intervention, of sorts” was how Fiona Godlee, editor-in-chief of The BMJ, described The BMJ’s new editorial policy, speaking at the recent Great Ormond Street Advances in Paediatrics Conference. The policy requires authors to declare the extent of patient involvement in any submitted research. What an intervention! Exposing the fact that only 10% of researchers can provide any evidence for patient involvement in designing, implementing, or reviewing studies is indeed highly significant and will have a huge impact on the ways we plan, perform, and present clinical research. Yet the qualification “of sorts” points to the recognition of the fact that measuring an intervention that influences culture and practice is far more difficult than recording the outcome of a scientific study.  

Tony Young, consultant urologist and director of Innovation at NHS England, speaking at the same conference, quoted Maya Angelou, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

Patients know how to measure the value of their clinicians. In a recent, beautifully written account, Sharon Roman articulated the qualities that she believes make a good—and exceptional—doctor; knowledge being “an obvious beginning but by no means the end.” Taking patients seriously, being honest, making people feel safe—“not only cared for but also cared about,” smiling, having strength of character… we all know that these are important attributes, yet how do we measure them, and how many points are they awarded on our application forms alongside our postgraduate degrees?

At the Risky Business Conference in May, a huge range of inspirational speakers discussed interventions that improve individual and team performance, enhance organisational culture, and achieve valuable change. There are many qualities and behaviours that are required to effect these, including humility, resilience, determination, adaptability, collaboration, and leading by example. Though these seem to be appreciated and acknowledged universally by clinical leaders, there remains a noticeable gap in how we can best demonstrate and quantify them.

While preparing for a recent job interview, I was considering how I would respond when asked, “What would you bring to the department?” We all know what sort of answers would enable the interviewers to put checks on the score-sheet: experience in research, teaching, audit, management—but what would my patients and colleagues want me to bring? A sense of humour, ability to learn, willingness to listen, flexibility, transparency, kindness, compassion, generosity, grace.

Don Berwick, former President and CEO of the US Institute for Healthcare Improvement points out that “every system is perfectly designed to get the results it gets.” Such is the case for our medical recruitment systems. We should, of course, continue to reward excellence in clinical academia, but we need to think more creatively about how we reward excellence in other areas of clinical practice which don’t provide such clearly identifiable and quantifiable metrics.

So for my next job application, by all means ask me to demonstrate how I have contributed to the body of scientific knowledge and advanced the frontiers of evidenced based medicine; request that I list my degrees, awards, and the conferences I’ve attended, but ask me too how I make people feel, because that’s what you really need to know.

 FineGoulden is a post-CCT Fellow in Paediatric Cardiac Intensive Care at Great Ormond Street Hospital for Children in London and also works for NHS England on the National Paediatric Critical Care and Specialised Surgery Review. She was on the FMLM National Medical Director’s Clinical Fellowship Scheme 2015/16. She tweets @finegoulden

 Competing interests: None declared.