“Data can’t change me!”
Many of the conversations grouped in this category were achieved using a
gender lens of practice in the ED. Most of the responses generated in
these discussions centered on the incongruence of values between
genders. Gender inequity in clinical practice was not explicitly
explored as part of this work, only reactions to data from each gender
subgroup. Although many of the discussions center on gender themes, the
logic used to discredit a data metric was seen across all subgroups of
participating respondents.
Female respondents demonstrated a significant aversion to throughput
metrics. Themes were based on sentiments of higher clinical scrutiny for
female practitioners as well as reduced value placed on throughput
measures.
“We are also way more cautious and way more scrutinized than our male
colleagues are.” [P14]
“I would say less women are driven so much by the money aspect of it
than the guys are. So, the guys are usually much more driven by how many
patients they see and what they bill etc.. And that is not entirely true
for everybody but whereas women seem to be less drawn into it.”
[P10]
Instead, female practitioners stated they placed more emphasis on
metrics related to the quality of patient care than those related to
throughput, an element otherwise seen as a positive attribute previously
quoted as an enabling feature. The aspect of this feedback which is
considered counterproductive is the outright rejection of a practice
metric in favor of another, a logic which could be broadly applied
throughout the range of metrics. This was also seen in a subset of
academic clinicians, who stated that adherence to practice guidelines
was more important than patient satisfaction, therefore minimizing the
patient experience.
“So, probably, women value the quality of care delivered to the
patients maybe or maybe they value more the spending time and
communicating better with their patients then the just sheer volume of
patients seen per shift… [M]aybe they value you know better
care for patient care than volume. And that is a different way to look
at things.” [P2]
Some clinicians viewed data exercises such as audit and feedback as
attempts at practice standardization, leading to the belief that this
would remove physician autonomy. The views expressed within this section
of the manuscript raised important questions about our expectations of
care and practice uniformity.
“…if it becomes that this is secretly a process to make sure
that I act and behave like an automaton then it becomes a real problem
because physicians are wired appropriately or perhaps inappropriately to
really value that autonomy.” [P15]