I believe it does. Pointing out the negatives without providing some positive feedback from the vast majority of satisfied patients diminishes the value of the desired behavior and creates cynics out of former believers.

This positive reinforcement does not need to cost much. Just an occasional thumbs-up or a quick Happy-Gram does it for me. For others, money may be a significant motivator—that’s not to say that money wouldn’t motivate me, too. Being left alone regarding trivial matters goes a long way as well.

In spite of our education and compensation, everyone enjoys a pat on the back occasionally for a job well done. When this does not happen, human nature begins to take hold, and we ask ourselves why we are knocking ourselves out if all that is received is negative feedback.

In order to have a few higher percentage points of patient satisfaction or a few dollars more in billing, there will be costs unless there is some positive feedback. So what does this high-scrutiny environment cost?

These costs are difficult to measure but certainly have a high value. Cynicism can spread through a group like gastroenteritis through a kindergarten class. It kills esprit de corps and poisons innovation and spontaneity (and nap time).

Apathy, the ugly stepsister of cynicism, is never far behind. Suddenly, the desire to serve on hospital committees or volunteer to do extra work with students plummets like the popularity of Congress.

Finally, unhappiness sets in, and previously content physicians are reading the last few pages of newspapers such as this one. The weather is nice in Virginia, isn’t it?

Clearly, scrutiny of our practice is not the only factor in physician happiness, but it is an important part of the puzzle. As reimbursements fall and patient census goes up in many parts of the country, desirable physicians will be looking for greener pastures. The question hospitals and groups need to ask themselves is, What is the cost of making these doctors unhappy?

Are the cynicism, apathy, unhappiness, and physician turnover worth a couple of percentage points or a few extra bucks in billing? Is it worth the cost of recruiting or the inherent instability that high turnover can bring to a group?

There was some dew last night. I’m not washing the car. It’s not quite as shiny, but I’m happy until some bird dumps a load on my windshield.