As physicians, many of us were drawn to the medical field by a profound desire to serve humanity and alleviate suffering. We hear buzzwords in corporate work about values-led teams, but in the house of medicine, we have always been led by a strong sense of values. This calling propelled us through the rigorous demands of medical training—endless hours of study, countless lectures, sleepless nights, and missed personal milestones. We persevered through it all because we were committed to a cause greater than ourselves, grounded in our core values.

These values, though varied, commonly include:

• Alleviating patient and human suffering.
• Pursuing continual learning to provide the highest quality of care.
• Making a meaningful impact in the lives of others.
• Contributing to the medical and scientific body of knowledge.
• Offering a safe environment for healing.
• Continuing to pass down our learned knowledge to future generations.

Rarely, if ever, do we hear our colleagues aspire to be the fastest doctors or to prioritize the financial bottom line of their institutions. These are not the metrics that define our professional ethos. Instead, our careers are built on a value-based system focused on service, dedication, and commitment.

However, the contemporary medical landscape, influenced heavily by corporate cultures rooted in profit, often presents us with a myriad of metrics. It gets even more confusing because the metrics are also mixed in with those created by clinical care teams. So, while some metrics can reinforce our values, others may not align as well. It’s crucial for physicians, who in general like to be straight-A students, to learn to discern which metrics truly serve their values and their duty to the patient in front of them and which metrics might, at times, distance them.

I had the pleasure of working with a lovely geriatric EM researcher for many years. As part of her values of adding to the body of knowledge and reducing harm, she would send us quarterly feedback metrics on our prescribing of certain medications to patients over 65, medications that increased the risk for falls. This feedback, coupled with educational support, significantly improved my practice. This is a prime example of a metric that enhanced my commitment to my values of continuous learning and providing high-quality patient care coupled with safety.

Conversely, we encounter metrics that may conflict with our values. The “time to discharge” or “hospital length of stay” metric, a similar metric used both in emergency rooms and inpatient settings, is one such example. While it can help ensure efficiency and financial viability, it occasionally pressures us to compromise on patient care. For example, discharging a vulnerable patient during unsafe hours (often to sit in the waiting room) simply to improve discharge times undermines our duty to individual patient care. Similarly, Dr. Maryann Wilbur, a gynecologic oncologist, faced challenges with the increased length of stay metrics when she chose open surgery for a patient with ovarian cancer for better patient outcomes over less invasive methods. The literature supports open surgery, but the metric does not. She ultimately chose to leave medicine and create support for physicians around this.

Such conflicts between professional values and imposed metrics can be profound, and it is important to have a framework to understand why. As physicians, many of us also hold a value of doing what is asked of us, of getting the A, and so getting a demerit on a metric can feel quite disheartening. But if we take a step back to analyze the metric, we can have more clarity on why we may be able to accept the demerit.

I urge physicians to approach metrics with a critical eye. Not all metrics warrant equal consideration. Evaluate them through the lens of your values—if a metric does not support or even contradict your values, give yourself permission to disregard it, maybe not completely, but at least for individual situations and cases.

Your dedication and skill development over the years are invaluable. Seeking feedback and striving for improvement are commendable goals, akin to how we approach clinical trials and studies—where the methodology is critical. Ensuring that the metrics are created in a way that aligns with what you value is not just important; it’s essential for maintaining the integrity of our profession.

As we navigate the changes in medicine, let us remember that our primary commitment is to the well-being of our patients, guided by the enduring values that inspired us to become physicians in the first place. We hold a lot more power than we often know.

Shideh Shafie is an emergency physician.