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A Piece of My Mind
October 22/29, 2014

What Gets Measured Gets (Micro)managed

Author Affiliations
  • 1Division of Hospital Medicine, Department of Medicine, University of California, San Francisco
JAMA. 2014;312(16):1637-1638. doi:10.1001/jama.2014.11268

When I became an attending physician in 2002, the rules were unwritten but clear: The residents ran the service, and I knew where I stood—in the background. I was to get involved only when necessary, usually meaning if a consultant was being particularly unhelpful, if there was a thorny goals-of-care discussion, or if a patient directly asked for the attending’s opinion. Anything else would result in receiving the worst label you could get as an attending: “micromanager.”

Micromanagers were guilty of a variety of sins—calling unnecessary consultations, holding up discharges, challenging medication choices—that boiled down to meddling in decisions rightly made by residents. During residency, we all swapped stories of the offenses the micromanagers perpetrated—the cardiologist who demanded to know each patient’s furosemide dose, the oncologist who kept a patient hospitalized to receive outpatient chemotherapy, the hospitalist who had to be called within an hour of every new admission. We respected the attendings who were master diagnosticians and teachers, but daily management was our territory. When the schedules were posted in the house staff office before each month, a glance at the attending assignments would elicit a frustrated sigh if the attending was a known micromanager or a smile of relief with one of the “good” ones. If you were unlucky enough to draw a micromanager, all you could do was grit your teeth and count the days until the month was up.

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