On Quality Care
by Daniel Neff, M.D.
Daniel Neff, M.D. is a board-certified psychiatrist and addiction psychiatrist dedicated to advancing evidence-based treatment for substance use disorders. He completed his undergraduate studies in Biology at Duke University before earning his medical degree from Jefferson Medical College. Dr. Neff then pursued residency training in psychiatry at Thomas Jefferson University Hospital, followed by fellowship training in Addiction Psychiatry at the University of Pennsylvania.
Dr. Neff currently serves as Medical Director of the Mirmont Treatment Center within Main Line Health and as an Addiction Psychiatrist with Mirmont Outpatient Centers. He has previously held multiple leadership roles at Thomas Jefferson University Hospital, including Associate Medical Director of the MATER and My Sister’s Place treatment programs and Associate Clerkship Director for the Department of Psychiatry and Human Behavior.
Committed to medical education, Dr. Neff has held faculty roles at Sidney Kimmel Medical College and currently serves on the volunteer faculty of the Philadelphia College of Osteopathic Medicine. His scholarly work includes peer-reviewed publications, book chapters, and presentations at local and national conferences, particularly in addiction psychiatry, psychopharmacology, and the intersection of medical and psychiatric care.
Dr. Neff is active in professional leadership and committees, including service within the American Psychiatric Association and Philadelphia Psychiatric Society, where he formerly served as Secretary. He has been recognized with several awards for teaching, humanism, and excellence in clinical care.
On Quality Care
The modern medical landscape is saturated with calls to deliver quality care. Many of these initiatives are driven not only by the business side of medicine, but by the growing influence of non-physician stakeholders. There is no question that quality is central to our work. We should measure and assess it vigorously to ensure the best outcomes for our patients. Administrators understandably gravitate toward tangible metrics—readmission rates, symptom-scale reductions, timely completion of treatment plans. Yet our identity and training as physicians require us to view quality through another, arguably more important, lens.
My own practice is grounded in a fundamentally Rogerian stance: quality care (noun) depends on quality caring (verb). Put simply, we cannot deliver high-quality care unless we actively communicate high-quality caring. Although the therapeutic relationship has long been recognized as the single largest contributor to outcomes in psychotherapy, it remains underemphasized in addiction treatment, where stigma still shapes expectations and practice.
Consider a recent example. A patient came to see me after a troubling experience in the community. He had been struggling with opioid addiction and sought a Sublocade induction from a nurse practitioner. Despite having used opioids in the clinic bathroom minutes before, he was incorrectly reassured that he would not experience withdrawal because “Sublocade does not contain Naltrexone.” On his way home, he became increasingly ill and called the clinic. The correct diagnosis—alpha-2-agonist withdrawal—was apparently made but never communicated to him. He was asked if he had any clonidine on hand. When he reported that he had none and didn’t even know what that was, he was advised to “take some Advil” and call back if things worsened. The clinician then left for the day and was unavailable for follow-up. Over the ensuing hours he became increasingly ill despite his futile attempt to manage symptoms using supplemental sublingual buprenorphine. Ultimately, the patient presented to the emergency department, where he finally received appropriate treatment.
This episode reflects several forms of low-quality caring:
- Not caring enough to be adequately educated about the basic pharmacology of prescribed medications.
- Not caring enough to call in a clonidine prescription when the patient clearly needed one.
- Not caring enough to provide accurate medical guidance.
- Not caring enough to remain available—or ensure someone else was—to manage complications.
When the patient arrived in my clinic, he was visibly surprised when I asked about his religious background, childhood, family relationships, and personal interests. He straightened in his chair and said, “I didn’t know we were actually going to talk about that stuff. It’s not what I’m used to.” He wasn’t wrong. Managed care pressures, scope creep, and the relentless pursuit of productivity metrics have created an environment where genuine caring—difficult to quantify and impossible to reduce to a dashboard—is increasingly rare.
As psychiatrists, we are uniquely trained to champion the truth that quality care is quality caring. Our field has always understood that the therapeutic relationship is not an accessory to treatment; it is the treatment. In a system obsessed with metrics, we must continue to advocate for the human elements of care that cannot be captured in a spreadsheet but remain essential to healing. Most of all we must communicate this caring to our patients where it can produce genuine quality and healing.