Tevlin: Physician laments a system that has gone from magic to metrics

On the morning after his last day as a physician, Dr. Stephen Zuckerman, 73, sat in a cafe and lamented a health care system that had left him behind.

For more than 20 years, Zuckerman had cared for a largely poor and underserved patient list at the former Aspen clinic on E. Lake Street. Then it was bought by Allina Health, beginning what he calls "the corporatization of the clinic."

While Zuckerman technically retired, he said he was essentially fired, given four months to attend to longtime patients.

Allina had incorporated a new customer survey called a "patient experience score" (PES), and by his own admission, Zuckerman was doing poorly. He showed me a colored graph that said only 10 percent of his patients who bothered to respond would recommend the clinic.

"At first I thought, holy … nobody likes me," said Zuckerman. "I was ready to quit medicine. Yet I was booked way out to the future with patients I'd seen for 15 years. It didn't make sense."

But Zuckerman came to realize that the sample size was tiny. He hadn't bothered to tell patients who liked him to fill it out. When he did, after he was fired, he said his scores rose dramatically.

"I told them the PES was voodoo, and I proved it," Zuckerman said. "The survey obfuscates reality. I think it was meant to confuse people."

But it was too late. Zuckerman had raised a ruckus and questioned the system. He showed me correspondence with bosses that characterized him as "unprofessional and unnecessarily negative."

"[A boss] said I had trouble dealing with authority," Zuckerman said. "He's right. I'm a very positive person, I'm just negative about B.S."

An Allina spokesman said that because personnel issues are private, they could not respond.

Zuckerman was candid about his shortcomings, but he claims most of them had to do with bookkeeping and bureaucracy and almost nothing to do with the art of medicine.

He readily talked about being disciplined in 2005 for overprescribing narcotics to a patient and failing to keep good records, for which he was suspended. After taking required courses, Zuckerman was reinstated in 2007.

"This is not a David and Goliath story," Zuckerman said. "Allina is not the enemy. They can bring lots of resources to help people in that community, and the people at the clinic are the most dedicated group I know. But because of the population they serve, they can't match the outcomes of the suburbs and are treated like a failure."

His new bosses, Zuckerman said, "became fixated on the metrics coming out of the computer. They are going to find they built a square wheel and their outcomes long term won't be good."

He was criticized for not being able to adapt to the computer era.

"I said, get me a scribe. You've made me into a scribe and a typist," said Zuckerman. "I want 30 minutes to be with the patient, they wanted 15. But patients have all kinds of problems that are interrelated. You can't get into their heads in 15 minutes."

Zuckerman's surveys were low, but he has a satchel of letters from patients saddened to see him go.

Several of them wrote or called the newspaper in past weeks to protest Zuckerman's removal.

"Stephen is a rare breed that truly cares about his patients," said client David Goldstein. "He doesn't rush, makes you feel at ease and is a fantastic physician. His skill, life experiences and empathy are on a level that not many reach. I wouldn't see anyone else."

Zuckerman said he grew up wanting to be a doctor because of a legendary physician, Gabriel Kirchbaum, who treated everyone in his Brooklyn neighborhood.

Having a near-death experience, suffering through depression and having a working-class upbringing have made Zuckerman more empathetic than ever.

"I was built to do this work," Zuckerman said. "They've taken all my experiences and wiped them out of their corporate needs. I'm at the height of capability and patient care, and I'm near my peak as a human being."

"They didn't like me. They said I would be happier at another clinic," said Zuckerman. "I said, 'Yes, but here I can change people's lives.'

"I do rub people the wrong way," Zuckerman acknowledged. "But I rub people the right way, too. I'm gregarious. If someone described me as manic, I say, 'No, I'm just from New York.' "

On Wednesday morning, Zuckerman's mood was bittersweet after leaving the profession he loved for so long. He joked about setting up medical consultations at a nearby restaurant, Muddy Waters.

"I was thinking about my life, and thought I've got to get on with it," said Zuckerman. "In a way, I'm relieved. I thanked them for firing me because it saved me from having to quit. I couldn't abandon my patients. My responsibility to them kept me up at nights. My head and their heads fit into each other. "

Zuckerman is working on a novel. He's on the board of several companies. He already has a book of his quips and wisdom called "Zuckerisms." He said he plans to stay active in his community.

"It goes back to shamanism, where there were people in a community meant to help other people," Zuckerman said. "How much of medicine is magic, and how much is Lipitor? They want to ignore that magic."

jtevlin@startribune.com • 612-673-1702

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