The Unintended Consequences of Measuring Quality on the Quality of Medical Care

It was midafternoon, and I was 30 minutes behind schedule. My next appointment was with a new patient, Mr. H., a 50-year-old man whose chief symptom was headaches. I spent more than the scheduled time with Mr. H., but the visit went well. I made a diagnosis of tension headaches, which he accepted after some explanation. As I put my hand on the doorknob to leave the room, now 40 minutes behind schedule (this wouldn't help my scores on surveys of patient and staff satisfaction), Mr. H. said, “Oh, by the way, sometimes I get a bit more short of . . .